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General NPI Number Information
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NPI Number | 1114446218
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Entity Type | Organization
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Legal Business Name | SHORE DENTAL, LLC
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Dates
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Enumeration Date | 09/11/2017
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Last Update Date | 09/11/2017
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Provider Practice Location Address
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Address Line | 4901 WHITE IBIS DRIVE
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City | NORTH PORT
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State | FL
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Zip | 34287
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Country | US
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Telephone | 941-474-9548
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Fax |
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Provider Business Mailing Address
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Address Line | 1861 PLACIDA RD STE 105
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City | ENGLEWOOD
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State | FL
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Zip | 34223-4900
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Country | US
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Telephone | 941-474-9548
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Fax | 941-475-6745
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | NOELLE SCHMITZ
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Credential |
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Telephone | 941-474-9548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | FL
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