Provider Demographics
NPI:1710024013
Name:SHIN, DONGJIN (DDS)
Entity type:Individual
Prefix:DR
First Name:DONGJIN
Middle Name:
Last Name:SHIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 OLD ORCHARD ROAD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-1317
Mailing Address - Country:US
Mailing Address - Phone:856-986-6606
Mailing Address - Fax:856-751-0593
Practice Address - Street 1:658 N BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:RUNNEMEDE
Practice Address - State:NJ
Practice Address - Zip Code:08078-1370
Practice Address - Country:US
Practice Address - Phone:856-939-3405
Practice Address - Fax:856-939-0104
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022196001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice