Provider Demographics
NPI:1811583164
Name:SHORELINE ENDODONTICS, P.C.
Entity Type:Organization
Organization Name:SHORELINE ENDODONTICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:231-947-6000
Mailing Address - Street 1:1087 BUSINESS PARK DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-8372
Mailing Address - Country:US
Mailing Address - Phone:231-947-6000
Mailing Address - Fax:231-947-6593
Practice Address - Street 1:1087 BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-8372
Practice Address - Country:US
Practice Address - Phone:231-947-6000
Practice Address - Fax:231-947-6593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1972094639OtherNPI TYPE 1 DR. BARRORD
MI1215190970OtherNPI TYPE 1 DR. ALLEN
MI1386743219OtherNPI TYPE 1 DR. HAAG