Organization
SHORELINE ANESTHESIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS JOHN SCHAFFER DDS (PRESIDENT)
(718) 644-0622
Entity
Organization
Contact information
Practice address
101 N UNION ST UNIT 533, KOKOMO, IN 46901-5045
(718) 644-0622
Mailing address
101 N UNION ST UNIT 533, KOKOMO, IN 46901-5045
(718) 644-0622
Taxonomy
Speciality
Code
Description
License number
State
1223D0004X
Dental Anesthesiology
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1780052936
—
MP
Enumeration date
01/12/2021
Last updated
01/12/2021
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