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General NPI Number Information
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NPI Number | 1922405901
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Entity Type | Organization
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Legal Business Name | SHORELINESMILES PA
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Dates
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Enumeration Date | 11/19/2014
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Last Update Date | 11/19/2014
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Provider Practice Location Address
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Address Line | 1230 W INDIANTOWN RD SUITE 101
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City | JUPITER
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State | FL
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Zip | 33458-3904
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Country | US
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Telephone | 561-743-8877
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Fax |
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Provider Business Mailing Address
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Address Line | 1230 W INDIANTOWN RD SUITE 101
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City | JUPITER
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State | FL
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Zip | 33458-8825
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Country | US
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Telephone | 561-743-8877
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEFF V. RISO
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Credential | DDS
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Telephone | 561-743-8877
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN16427
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License Number State | FL
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