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General NPI Number Information
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NPI Number | 1114331931
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Entity Type | Organization
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Legal Business Name | SHORELINE CHILDRENS DENTISTRY
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Dates
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Enumeration Date | 06/19/2014
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Last Update Date | 08/11/2014
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Provider Practice Location Address
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Address Line | 934 BOSTON POST RD SUITE 3-A
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City | GUILFORD
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State | CT
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Zip | 06437-2713
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Country | US
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Telephone | 860-575-0594
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Fax | 860-349-1481
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Provider Business Mailing Address
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Address Line | 934 BOSTON POST RD SUITE 3-A
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City | GUILFORD
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State | CT
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Zip | 06437-2713
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Country | US
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Telephone | 860-575-0594
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Fax | 860-349-1481
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Authorized Official
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Title or Position | MEMBER
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Name | DR. KATHRYN MARGARET GLAZER
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Credential | D.M.D.
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Telephone | 860-575-0594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 009873
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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