Provider Demographics
NPI:1255098620
Name:SHIN PROSTHODONTICS LLC
Entity type:Organization
Organization Name:SHIN PROSTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONGJIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:857-540-2066
Mailing Address - Street 1:5904 HUBBARD DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4823
Mailing Address - Country:US
Mailing Address - Phone:301-377-8306
Mailing Address - Fax:240-387-6945
Practice Address - Street 1:5904 HUBBARD DR
Practice Address - Street 2:
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-4823
Practice Address - Country:US
Practice Address - Phone:301-377-8306
Practice Address - Fax:240-387-6945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-20
Last Update Date:2021-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty