Individual
BRYAN WONTAEK SHIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
13760 LAKERIDGE DR, FISHERS, IN 46037-7608
(317) 588-2575
Mailing address
9723 NORTHFORK DR, BRENTWOOD, TN 37027-8334
(615) 707-0330
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
12014784A
IN
Other
Enumeration date
05/01/2023
Last updated
07/17/2025
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