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General NPI Number Information
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NPI Number | 1851765275
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Entity Type | Organization
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Legal Business Name | SHORELINE DENTAL CARE LLC
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Dates
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Enumeration Date | 11/23/2015
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Last Update Date | 03/23/2016
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Provider Practice Location Address
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Address Line | 255 CHERRY ST STE C
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City | MILFORD
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State | CT
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Zip | 06460-3503
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Country | US
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Telephone | 203-874-3050
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Fax | 203-874-3990
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Provider Business Mailing Address
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Address Line | 255 CHERRY ST STE C
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City | MILFORD
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State | CT
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Zip | 06460-3503
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Country | US
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Telephone | 203-931-3050
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Fax | 203-931-3055
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | DR. JOSEPH DAVID TARTAGNI
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Credential | D.M.D.
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Telephone | 203-931-3050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | CT006676
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License Number State | CT
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