Provider Demographics
NPI:1518401066
Name:WEST SHORE FAMILY DENTAL LLC
Entity Type:Organization
Organization Name:WEST SHORE FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASARELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-276-1586
Mailing Address - Street 1:141 CAPTAIN THOMAS BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-5914
Mailing Address - Country:US
Mailing Address - Phone:203-932-3675
Mailing Address - Fax:203-934-9701
Practice Address - Street 1:141 CAPTAIN THOMAS BLVD
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-5914
Practice Address - Country:US
Practice Address - Phone:203-932-3675
Practice Address - Fax:203-934-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-16
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT114621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty