Provider Demographics
NPI:1811576507
Name:SHIN, RENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RENE
Middle Name:
Last Name:SHIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MAPLE AVE STE 5C
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1729
Mailing Address - Country:US
Mailing Address - Phone:732-337-8808
Mailing Address - Fax:
Practice Address - Street 1:130 MAPLE AVE STE 5C
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1729
Practice Address - Country:US
Practice Address - Phone:732-337-8808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT130481223E0200X
NJ22DI028769001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics