Healthcare Provider Details

I. General information

NPI: 1740338979
Provider Name (Legal Business Name): DEBRA HSU SHIN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBRA D HSU DDS

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11325 SEVEN LOCKS RD STE 256
POTOMAC MD
20854-3230
US

IV. Provider business mailing address

11325 SEVEN LOCKS RD STE 256
POTOMAC MD
20854-3230
US

V. Phone/Fax

Practice location:
  • Phone: 301-770-7770
  • Fax: 301-770-7776
Mailing address:
  • Phone: 301-770-7770
  • Fax: 301-770-7776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number15637
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: