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General NPI Number Information
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NPI Number | 1750049417
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Entity Type | Organization
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Legal Business Name | SHORELINE DENTAL STUDIO PLLC
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Dates
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Enumeration Date | 11/30/2021
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Last Update Date | 11/30/2021
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Provider Practice Location Address
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Address Line | 34 WALTER MARTIN RD NE
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-4960
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Country | US
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Telephone | 760-528-0275
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Fax |
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Provider Business Mailing Address
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Address Line | 4 OKAHATCHEE CIR SE
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-5711
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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 | OWNER/MEMBER
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Name | DR. ASHLEY DUBOIS
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Credential | DDS
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Telephone | 760-528-0275
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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 |
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License Number State |
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