Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 37162 | TX |
NPI | 1114377009 |
---|---|
Provider Name | Lauren Shin |
First Address | Fort Worth, TX 76126-2641 |
Second Address | Willow Park, TX 76087-8864 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2016 |
Last Update Date | 30/06/2021 |