Provider Demographics
NPI:1851765275
Name:SHORELINE DENTAL CARE LLC
Entity Type:Organization
Organization Name:SHORELINE DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:TARTAGNI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-931-3050
Mailing Address - Street 1:255 CHERRY ST STE C
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3503
Mailing Address - Country:US
Mailing Address - Phone:203-931-3050
Mailing Address - Fax:203-931-3055
Practice Address - Street 1:255 CHERRY ST STE C
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3503
Practice Address - Country:US
Practice Address - Phone:203-874-3050
Practice Address - Fax:203-874-3990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT006676332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1457486706OtherINDIVIDUAL NPI #
CT1457486706OtherINDIVIDUAL NPI #