Healthcare Provider Details

I. General information

NPI: 1356947972
Provider Name (Legal Business Name): SHOREVIEW FAMILY DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 12/09/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 NORTH CASCADE ST
OSCEOLA WI
54020
US

IV. Provider business mailing address

3261 305TH AVE NE
CAMBRIDGE MN
55008-6704
US

V. Phone/Fax

Practice location:
  • Phone: 715-294-3303
  • Fax:
Mailing address:
  • Phone: 651-470-9590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ADAM CURTIS
Title or Position: OWNER
Credential: DDS
Phone: 651-494-7995