Provider Demographics
NPI:1871994806
Name:SHIN ORTHODONTICS
Entity type:Organization
Organization Name:SHIN ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-770-7770
Mailing Address - Street 1:4701 RANDOLPH RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2257
Mailing Address - Country:US
Mailing Address - Phone:301-770-7770
Mailing Address - Fax:301-770-7776
Practice Address - Street 1:4701 RANDOLPH RD
Practice Address - Street 2:SUITE 108
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2257
Practice Address - Country:US
Practice Address - Phone:301-770-7770
Practice Address - Fax:301-770-7776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD136851223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty