Provider Demographics
NPI:1649646084
Name:SHIN, STEPHANIE SUHYOUNG (DDS, MS)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SUHYOUNG
Last Name:SHIN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 PACKARD ST STE 301
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-3874
Mailing Address - Country:US
Mailing Address - Phone:734-662-1591
Mailing Address - Fax:734-662-1599
Practice Address - Street 1:1303 PACKARD ST STE 301
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-3874
Practice Address - Country:US
Practice Address - Phone:734-662-1591
Practice Address - Fax:734-662-1599
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010213141223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice