Organization
BREAKWATER DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHILO ANNIS DMD (OWNER/DENTIST)
(207) 272-9847
Entity
Organization
Contact information
Practice address
25 LONG CREEK DR UNIT D, SOUTH PORTLAND, ME 04106-2440
(207) 775-2072
Mailing address
5 MIDNIGHT LN, GORHAM, ME 04038-2376
(207) 272-9847
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/29/2021
Last updated
03/29/2021
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