Provider Demographics
NPI:1689122541
Name:DANIEL C SHIN, DDS, PC
Entity Type:Organization
Organization Name:DANIEL C SHIN, DDS, PC
Other - Org Name:DIAMOND ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-486-3636
Mailing Address - Street 1:2835 SMITH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-1454
Mailing Address - Country:US
Mailing Address - Phone:410-486-3636
Mailing Address - Fax:410-486-3657
Practice Address - Street 1:2835 SMITH AVE STE B
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-1454
Practice Address - Country:US
Practice Address - Phone:410-486-3636
Practice Address - Fax:410-486-3657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD157911223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty