Provider Demographics
NPI:1578605960
Name:SHORELINE DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:SHORELINE DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:PILGRIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-434-7279
Mailing Address - Street 1:100 HALLS RD
Mailing Address - Street 2:PO BOX 397
Mailing Address - City:OLD LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06371-1456
Mailing Address - Country:US
Mailing Address - Phone:860-434-7279
Mailing Address - Fax:
Practice Address - Street 1:100 HALLS RD
Practice Address - Street 2:
Practice Address - City:OLD LYME
Practice Address - State:CT
Practice Address - Zip Code:06371-1456
Practice Address - Country:US
Practice Address - Phone:860-434-7279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty