Breakwater Dental, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

BREAKWATER DENTAL, LLC

Practice address

25 Long Creek Dr Unit D
South Portland, ME 04106-2440

Phone

(207) 775-2072

NPI assigned

Mar 29, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Shilo Annis, DMD

Title

Owner/Dentist

Phone

(207) 272-9847

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1616976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616976000000",
    "number": "1811575202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 MIDNIGHT LN",
            "city": "GORHAM",
            "state": "ME",
            "postal_code": "040382376",
            "telephone_number": "207-272-9847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 LONG CREEK DR UNIT D",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041062440",
            "telephone_number": "207-775-2072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREAKWATER DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-29",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A",
        "authorized_official_last_name": "ANNIS",
        "authorized_official_first_name": "SHILO",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "207-272-9847",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steffanie Brackett, PSY.D., BCBA-D
• Nicole Annette Bradley
• Margaret Derose Braga, LCPC, LSW
• Mary C Brandes, MD
• Stuart Vasche Braun, MD
• Cory Breidt
• Colm J Brennan, LCSW
• Nathan P Brewster, DPT
• Nancy Elaine Briggs Coffin, LCSW
• Melissa Briggs, CPM, LM

• All providers in South Portland, ME
• General Practice Dentistry in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2021; 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.