SHORELINE PERIODONTICS, PC
NPI 1679684757
Dentist - Periodontics in New London, CT

NPI Status: Active since August 31, 2006

Contact Information

190 HEMPSTEAD ST
NEW LONDON, CT
ZIP 06320
Phone: (860) 443-5298
Fax: (860) 443-6704

NPI Profile Information
Primary Taxonomy
Secondary Taxonomies
Group Taxonomy
Secondary Locations
Authorized Official
CLIA Information
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Organization
Dentist
Periodontics
CLIA Number: 07D0095270
CLIA Cert. Type: Physician Office
CLIA Exp. Date: 03-23-2027

About SHORELINE PERIODONTICS, PC

This page provides the complete NPI Profile along with additional information for Shoreline Periodontics, Pc, a provider established in New London, Connecticut operating as a Dentist, focusing in periodontics . The healthcare provider is registered in the NPI registry with number 1679684757 assigned on August 2006. The practitioner's primary taxonomy code is 1223P0300X with license number 8455 (CT). The provider is registered as an organization and their NPI record was last updated 3 years ago. The organization operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The authorized official of this NPI record is Dr. Gregory A Toback Dmd, Ms (President)

NPI: 1679684757
Provider Name: SHORELINE PERIODONTICS, PC
Entity Type: Organization
Location Address: 190 HEMPSTEAD ST NEW LONDON, CT 06320
Location Phone: (860) 443-5298
Location Fax: (860) 443-6704
Mailing Address: 190 HEMPSTEAD ST NEW LONDON, CT 06320
Mailing Phone: (860) 443-5298
Mailing Fax: (860) 443-6704
Is Sole Proprietor?: No
Is Organization Subpart?: No
Enumeration Date: 08-31-2006
Last Update Date: 02-22-2022
Code Navigator

A dentist like Shoreline Periodontics, Pc is a skilled in and licensed provider that diagnoses and treats problems with patients teeth, gums, and related parts of the mouth. Dentists educate patients on how to take care of the teeth and gums and provide information on diet choices that affect oral health. Dentists must be licensed in the state in which they work.

Location Map

Secondary Locations

535 Saybrook Rd Ste 5
Middletown, CT 06457
(860) 346-9665

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Dentist Periodontics
Taxonomy Code: 1223P0300X
Type: Dental Providers
License No.: 8455
License State: CT
Taxonomy Description: That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No.	Taxonomy Code	Type	Classification / Specialization	License No. (State)
1	1223P0300X	Dental Providers	Dentist Periodontics	2628 (RI)

Group Taxonomy 193400000X MULTIPLE SINGLE SPECIALTY GROUP

This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name: DR. GREGORY A TOBACK DMD, MS
Authorized Official Title: PRESIDENT
Authorized Official Phone: (860) 443-5298

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number: 07D0095270
Facility Type: Physician Office
Certificate Effective Date: March 24, 2025
Certificate Expiration Date: March 23, 2027
Laboratory Director: MICHAEL A. LAVALLEE
Certificate Type: Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description: This CLIA certificate is issued to Shoreline Periodontics, Pc in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.

NPI Validation Check Digit Calculation

The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1	6	7	9	6	8	4	7	5	7
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2	6	14	9	12	8	8	7	10
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 6 + 1 + 4 + 9 + 1 + 2 + 8 + 8 + 7 + 1 + 0 + 24 = 73
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
80 - 73 = 7									7

The NPI number 1679684757 is valid because the calculated check digit 7 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location

The following 10 providers are registered at the same or nearby location.

DR. STEVEN D URELES DMD, MS

Dentist

(Pediatric Dentistry)