Provider Demographics
NPI:1740338979
Name:SHIN, DEBRA HSU (DDS)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:HSU
Last Name:SHIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:DEBRA
Other - Middle Name:D
Other - Last Name:HSU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:4701 RANDOLPH RD STE 108
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2260
Mailing Address - Country:US
Mailing Address - Phone:301-770-7770
Mailing Address - Fax:301-770-7776
Practice Address - Street 1:4701 RANDOLPH RD STE 108
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2260
Practice Address - Country:US
Practice Address - Phone:301-770-7770
Practice Address - Fax:301-770-7776
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD156371223X0400X
TNDS00000094281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD085247300Medicaid
DC066842300Medicaid