Provider Demographics
NPI:1801956727
Name:THE SHORELINE FAMILY DENTAL GROUP PC
Entity type:Organization
Organization Name:THE SHORELINE FAMILY DENTAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOEKSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-339-9520
Mailing Address - Street 1:1121 OTTAWA BEACH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424
Mailing Address - Country:US
Mailing Address - Phone:616-399-9520
Mailing Address - Fax:616-399-0945
Practice Address - Street 1:1121 OTTAWA BEACH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424
Practice Address - Country:US
Practice Address - Phone:616-399-9520
Practice Address - Fax:616-399-0945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty