Organization
SHORELINE PERIODONTICS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY A TOBACK DMD, MS (PRESIDENT)
(860) 443-5298
Entity
Organization
Contact information
Practice address
190 HEMPSTEAD ST, NEW LONDON, CT 06320-6248
(860) 443-5298
(860) 443-6704
Mailing address
190 HEMPSTEAD ST, NEW LONDON, CT 06320-6248
(860) 443-5298
(860) 443-6704
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
2628
RI
1223P0300X
Periodontics
Primary
8455
CT
Other
Enumeration date
08/31/2006
Last updated
02/22/2022
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