NPIMap

Organization Active NPI

Shoreline Dental Associates, P.C.

  • Dentist
  • Muskegon, MI
National Provider Identifier
1144327412
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2901012036 Issued in MI
Legal business name
SHORELINE DENTAL ASSOCIATES, P.C.
Practice address
1221 E Sherman Blvd
Muskegon, MI 49444-1811
Phone
(231) 739-5105
Fax
(231) 739-7432
NPI assigned
Sep 20, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Charles Hobart Keever III, D.D.S.NPI 1598865073
Title
President
Phone
(231) 739-5105

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 2901012036 MI Primary

Addresses

Primary practice location

1221 E Sherman Blvd
Muskegon, MI 49444-1811

Mailing address

1221 E Sherman Blvd
Muskegon, MI 49444-1811
Phone (231) 739-5105

Other identifiers 1

IdentifierTypeStateIssuer
2574566MedicaidMI

National Provider Directory

National Provider Directory

Locations

1221 E Sherman Blvd
Norton Shores, MI 49444
Phone (231) 638-4581

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1144327412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 E SHERMAN BLVD",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494441811",
            "telephone_number": "231-739-5105",
            "fax_number": "231-739-7432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 E SHERMAN BLVD",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494441811",
            "telephone_number": "231-739-5105",
            "fax_number": "231-739-7432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORELINE DENTAL ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KEEVER",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "HOBART",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "231-739-5105",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901012036",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2574566",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Muskegon, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.