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General NPI Number Information
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NPI Number | 1538696026
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Entity Type | Organization
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Legal Business Name | SHORELINE FAMILY DENTAL, LLC
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Dates
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Enumeration Date | 05/16/2017
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Last Update Date | 05/16/2017
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Provider Practice Location Address
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Address Line | 100 HALLS RD STE 10-12
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City | OLD LYME
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State | CT
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Zip | 06371-1456
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Country | US
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Telephone | 860-434-7279
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Fax |
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Provider Business Mailing Address
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Address Line | 81 DANIELSON PIKE
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City | NORTH SCITUATE
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State | RI
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Zip | 02857-1892
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATIONS OFFICER
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Name | MS. SAMANTHA BURNELL
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Credential |
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Telephone | 401-578-0274
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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 | 193400000X
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License Number State |
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