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NPI Code Detail

MEDICARE: SHORELINE ENDODONTICS, P.C.

MEDICARE: SHORELINE ENDODONTICS, P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223E0200XEndodontics

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11972094639OTHERMINPI TYPE 1 DR. BARRORD
21215190970OTHERMINPI TYPE 1 DR. ALLEN
31386743219OTHERMINPI TYPE 1 DR. HAAG

General Provider Information

NPI Number : 1811583164
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHORELINE ENDODONTICS, P.C.
Provider Business Mailing Address
First Line : 1087 BUSINESS PARK DR
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49686-8372
Country : US
Telephone Number : 231-947-6000
Fax Number : 231-947-6593
Provider Business Practice Location Address
First Line : 1087 BUSINESS PARK DR
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49686-8372
Country : US
Telephone Number : 231-947-6000
Fax Number : 231-947-6593
Authorized Official
Title or Position : PRACTICE OWNER
Name : CHRISTOPHER M ALLEN
Credential : DDS, MS
Telephone Number : 231-947-6000
Provider Enumeration Date : 12/21/2020
Last Update Date : 12/21/2020

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Directions to “SHORELINE ENDODONTICS, P.C. ” Practice Location

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