Provider Demographics
NPI:1477577088
Name:SHORELINE DENTAL ASSOCIATES, S.C.
Entity Type:Organization
Organization Name:SHORELINE DENTAL ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LIPPERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-684-9685
Mailing Address - Street 1:1415 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-2051
Mailing Address - Country:US
Mailing Address - Phone:920-684-9685
Mailing Address - Fax:920-684-4895
Practice Address - Street 1:1415 N 8TH ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-2051
Practice Address - Country:US
Practice Address - Phone:920-684-9685
Practice Address - Fax:920-684-4895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty