Shoreline Periodontics, PC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

8455 Issued in CT

Legal business name

SHORELINE PERIODONTICS, PC

Practice address

190 Hempstead St
New London, CT 06320-6248

Phone

(860) 443-5298

Fax

(860) 443-6704

NPI assigned

Aug 31, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Gregory A Toback, DMD, MS

Title

President

Phone

(860) 443-5298

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645488000000",
    "number": "1679684757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 HEMPSTEAD ST",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063206248",
            "telephone_number": "860-443-5298",
            "fax_number": "860-443-6704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 HEMPSTEAD ST",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063206248",
            "telephone_number": "860-443-5298",
            "fax_number": "860-443-6704"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "535 Saybrook Rd Ste 5",
            "address_purpose": "LOCATION",
            "city": "Middletown",
            "state": "CT",
            "postal_code": "064574743",
            "country_code": "US",
            "telephone_number": "860-346-9665",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SHORELINE PERIODONTICS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2022-02-22",
        "certification_date": "2022-02-14",
        "status": "A",
        "authorized_official_last_name": "TOBACK",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "860-443-5298",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, MS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "CT",
            "license": "8455",
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "RI",
            "license": "2628",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sheridan Healthcare of Connecticut, PC
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• Gina Shin
• Jason A Shirley, MSW
• Shoreline Medical Supply, LLC
• Shoreline Pulmonary Associates LLC
• Shri Kris Verma MD
• Shri Verma MD Gastroenterology LLC
• Suzy Shukovsky, MD
• Waleed Tariq Siddiqui, MD

• Periodontics in New London, CT
• Providers in New London, CT by specialty
• Periodontics in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2022; 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.