Healthcare Provider Details

I. General information

NPI: 1609770817
Provider Name (Legal Business Name): IRENE C. SHIN DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5910 FREDERICK CROSSING LN STE 101
FREDERICK MD
21704-5141
US

IV. Provider business mailing address

5910 FREDERICK CROSSING LN STE 101
FREDERICK MD
21704-5141
US

V. Phone/Fax

Practice location:
  • Phone: 301-662-4422
  • Fax:
Mailing address:
  • Phone: 301-662-4422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: IRENE SHIN
Title or Position: OWNER
Credential: DDS
Phone: 240-401-5231