| NPI | 1134477532 |
|---|---|
| Other Name | SHORELINE MODERN DENTAL LLC |
| Entity Type | Organization |
| Authorized Contact | BRADLEY J. DAAR President/Owner 860-395-5200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2012-08-16 |
| Last Update Date | 2016-11-19 |