Basic Information
| Provider Information | |||||||||
| NPI: | 1457792749 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOON | ||||||||
| FirstName: | SHINSIL | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8924 RHYME CT | ||||||||
| Address2: | |||||||||
| City: | ANNANDALE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220033923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034770395 | ||||||||
| FaxNumber: | 8707790512 | ||||||||
| Practice Location | |||||||||
| Address1: | 2165 CUNNINGHAM DR | ||||||||
| Address2: | |||||||||
| City: | HAMPTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236662569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578275665 | ||||||||
| FaxNumber: | 7578270121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2013 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 3956 | AR | N | Dental Providers | Dentist | 1223G0001X | 0401414692 | VA | Y | Dental Providers | Dentist | General Practice |
No ID Information.