Provider Demographics
NPI:1518380310
Name:SHIN, PHILIP (DDS)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:SHIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 HIGHWAY 35 S
Mailing Address - Street 2:SUITH 3108
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2023
Mailing Address - Country:US
Mailing Address - Phone:732-460-0066
Mailing Address - Fax:
Practice Address - Street 1:180 HIGHWAY 35 S
Practice Address - Street 2:SUITH 3108
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-2023
Practice Address - Country:US
Practice Address - Phone:732-460-0066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02585800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist