| Organization Name: | SHORELINE CHILDRENS DENTISTRY |
| NPI Number: | 1114331931 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KATHRYN MARGARET GLAZER (MEMBER) |
| Mailing Address: | 934 Boston Post Rd Suite 3-a Guilford |
| State: | CT US |
| Postal Code: | 064372713 |
| Phone Number: | 8605750594 |
| Fax Number: | 8603491481 |
| NPI Enumeration Date: | 06/19/2014 |
| NPI Last Update Date: | 08/11/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 009873 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CT |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |