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SHORELINE PERIODONTICS PC NPI 1679684757


NPI Information

NPI: 1679684757
Provider Name: SHORELINE PERIODONTICS, PC
Classification: Dentist - 1223P0300X
Entity Type: Organization

Specialization: Periodontics

CLIA Number: 07D0095270

Address:
190 HEMPSTEAD ST
NEW LONDON, CT
ZIP 06320
Phone: (860) 443-5298
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SHORELINE PERIODONTICS, PC is a periodontics dentist in New London, CT. The provider is that specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. SHORELINE PERIODONTICS, PC NPI is 1679684757. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

190 HEMPSTEAD ST
NEW LONDON, CT
ZIP 06320-248
Phone: (860) 443-5298
Fax: (860) 443-6704

The provider's authorized official is Gregory A Toback .
The authorized official title is President and has the following contact phone number (860) 443-5298.

The CLIA number assigned to this NPI record is 07D0095270 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 8/31/2006 and was last updated on 2/22/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223P0300XDentistPeriodontics2628RHODE ISLANDNo
21223P0300XDentistPeriodontics8455CONNECTICUTYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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