Healthcare Provider Details

I. General information

NPI: 1871994806
Provider Name (Legal Business Name): SHIN ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2014
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 Number13685
License Number StateMD

VIII. Authorized Official

Name: RICHARD C SHIN
Title or Position: MEMBER
Credential:
Phone: 301-770-7770