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General NPI Number Information
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NPI Number | 1679761142
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Entity Type | Organization
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Legal Business Name | SHORELINE ORAL & MAXILLOFACIAL SURGEONS, PC
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Dates
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Enumeration Date | 10/10/2007
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Last Update Date | 10/10/2007
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Provider Practice Location Address
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Address Line | 1480 BOSTON POST RD
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City | OLD SAYBROOK
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State | CT
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Zip | 06475-1750
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Country | US
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Telephone | 860-388-5745
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Fax | 860-388-2145
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Provider Business Mailing Address
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Address Line | 1480 BOSTON POST ROAD
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City | OLD SAYBROOK
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State | CT
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Zip | 06475-1750
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Country | US
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Telephone | 860-388-5745
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Fax | 860-388-2145
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANDREW J. KRESSLEY
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Credential | DMD
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Telephone | 860-388-5745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 7920
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License Number State | DE
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