Shoreline Modern Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

SHORELINE MODERN DENTAL LLC

Practice address

191 Main St
Old Saybrook, CT 06475-2392

Phone

(860) 395-5200

NPI assigned

Aug 16, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Bradley J. Daar, DDS

Title

President/Owner

Phone

(860) 395-5200

Specialties & licenses 1

Addresses

Other names 1

• Shoreline Modern Dental LLC Other name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1345075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479513600000",
    "number": "1134477532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "191 MAIN STREET",
            "city": "OLD SAYBROOK",
            "state": "CT",
            "postal_code": "064752392",
            "telephone_number": "860-395-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 MAIN ST",
            "city": "OLD SAYBROOK",
            "state": "CT",
            "postal_code": "064752392",
            "telephone_number": "860-395-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORELINE MODERN DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-16",
        "last_updated": "2016-11-19",
        "status": "A",
        "authorized_official_last_name": "DAAR",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "860-395-5200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shoreline Modern Dental LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• General Practice Dentistry in Old Saybrook, CT
• Providers in Old Saybrook, CT by specialty
• General Practice Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.