Healthcare Provider Details

I. General information

NPI: 1366360117
Provider Name (Legal Business Name): PEDG BETHESDA ROW MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4825 BETHESDA AVE STE 308
BETHESDA MD
20814-5245
US

IV. Provider business mailing address

4825 BETHESDA AVE STE 308
BETHESDA MD
20814-5245
US

V. Phone/Fax

Practice location:
  • Phone: 301-377-8306
  • Fax:
Mailing address:
  • Phone: 301-377-8306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. DONGJIN SHIN
Title or Position: OWNER
Credential: DMD
Phone: 301-377-8306