=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396886727
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD C SHIN DDS, MS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2007
-----------------------------------------------------
Last Update Date | 10/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11325 SEVEN LOCKS RD STE 256
-----------------------------------------------------
City | POTOMAC
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20854-3230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-750-6699
-----------------------------------------------------
Fax | 301-770-7776
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11325 SEVEN LOCKS RD STE 256
-----------------------------------------------------
City | POTOMAC
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20854-3230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-770-7770
-----------------------------------------------------
Fax | 301-770-7776
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 13685
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------