Provider Demographics
NPI:1912240169
Name:SHIN, ESTHER (DMD)
Entity Type:Individual
Prefix:DR
First Name:ESTHER
Middle Name:
Last Name:SHIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41115 WINCHESTER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-6001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:41115 WINCHESTER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-6001
Practice Address - Country:US
Practice Address - Phone:951-331-7016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
CA63733122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program