Provider Demographics
NPI:1467971614
Name:ANNA SHIN DDS, INC
Entity Type:Organization
Organization Name:ANNA SHIN DDS, INC
Other - Org Name:MODERN DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MS
Authorized Official - First Name:HYUN WON
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-585-1838
Mailing Address - Street 1:422 MAIN ST FL 1
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2861
Mailing Address - Country:US
Mailing Address - Phone:201-585-1838
Mailing Address - Fax:
Practice Address - Street 1:422 MAIN ST FL 1
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-2861
Practice Address - Country:US
Practice Address - Phone:201-585-1838
Practice Address - Fax:201-585-1719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI0226700261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental