Organization
SHORELINE MODERN DENTAL LLC
Active
Other names
Shoreline Modern Dental LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADLEY J. DAAR DDS (PRESIDENT/OWNER)
(860) 395-5200
Entity
Organization
Contact information
Practice address
191 MAIN ST, OLD SAYBROOK, CT 06475-2392
(860) 395-5200
Mailing address
191 MAIN STREET, OLD SAYBROOK, CT 06475-2392
(860) 395-5200
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
CT
Other
Enumeration date
08/16/2012
Last updated
11/19/2016
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