| Shoreline Periodontics, Pc | |
|
190 Hempstead St New London CT 06320-6248 | |
| (860) 443-5298 | |
| (860) 443-6704 |
| Full Name | Shoreline Periodontics, Pc |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 190 Hempstead St, New London, Connecticut |
| Authorized Official Name and Position | Gregory A Toback (PRESIDENT) |
| Authorized Official Contact | 8604435298 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shoreline Periodontics, Pc 190 Hempstead St New London CT 06320-6248 Ph: (860) 443-5298 | Shoreline Periodontics, Pc 190 Hempstead St New London CT 06320-6248 Ph: (860) 443-5298 |
| NPI Number | 1679684757 |
|---|---|
| Provider Enumeration Date | 08/31/2006 |
| Last Update Date | 02/22/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679684757 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | 8455 (Connecticut) | Primary |
| 1223P0300X | Dentist - Periodontics | 2628 (Rhode Island) | Secondary |
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