Family Dentistry of Dr Jessica Shin, PLLC

Primary specialty

DentistTaxonomy code 122300000X

License

49328 Issued in NY

Legal business name

FAMILY DENTISTRY OF DR JESSICA SHIN, PLLC

Practice address

365 Aviation Rd
Queensbury, NY 12804-2915

Phone

(518) 798-5696

Fax

(518) 745-6854

NPI assigned

Mar 30, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jungwon Shin, DDS

Title

Owner/Dentist

Phone

(518) 798-5696

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Family Dentistry of Dr Jessica Shin PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Family Dentistry of Dr Jessica Shin, PLLC

  • Dentist
  • Queensbury, NY
  • NPI 1346529484
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1459296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459296000000",
    "number": "1376906156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "365 AVIATION RD",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128042915",
            "telephone_number": "518-798-5696",
            "fax_number": "518-745-6854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "365 AVIATION RD",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128042915",
            "telephone_number": "518-798-5696",
            "fax_number": "518-745-6854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY DENTISTRY OF DR JESSICA SHIN, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-30",
        "last_updated": "2016-03-30",
        "status": "A",
        "authorized_official_last_name": "SHIN",
        "authorized_official_first_name": "JUNGWON",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "518-798-5696",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NY",
            "license": "49328",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02408799",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eye Care Medicine Surgery PC
• Eyestudiony
• Fredric Ira Fagelman, MD
• Ashley Michelle Fallen
• Family Dentistry of Dr Jessica Shin, PLLC
• Julia Marie Fanning, OTR
• Martin S Farber, MD
• Kristy Marie Farmer, DO
• Colin Timothy Farrell
• Ghulam M Faruki, M.D.

• Dentist in Queensbury, NY
• Providers in Queensbury, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.