Provider Demographics
NPI:1770716607
Name:SHIN, DANIEL EDWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:EDWARD
Last Name:SHIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1121 W MICHIGAN STREET
Mailing Address - Street 2:DS307B
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5186
Mailing Address - Country:US
Mailing Address - Phone:317-278-3632
Mailing Address - Fax:317-274-2603
Practice Address - Street 1:1121 W MICHIGAN STREET
Practice Address - Street 2:DS307B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5186
Practice Address - Country:US
Practice Address - Phone:317-278-3632
Practice Address - Fax:317-274-2603
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0529401223P0300X
IN12011064A1223P0300X
KS607241223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics