Provider Demographics
NPI:1376789933
Name:SHORELINE PERIODONTICS LIMITED
Entity Type:Organization
Organization Name:SHORELINE PERIODONTICS LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HOGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:920-452-8802
Mailing Address - Street 1:2808 KOHLER MEMORIAL DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-3177
Mailing Address - Country:US
Mailing Address - Phone:920-452-8802
Mailing Address - Fax:920-452-2852
Practice Address - Street 1:2808 KOHLER MEMORIAL DR
Practice Address - Street 2:SUITE 2
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3177
Practice Address - Country:US
Practice Address - Phone:920-452-8802
Practice Address - Fax:920-452-2852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty