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BREAKWATER DENTAL, LLC
NPI 1811575202
Dentist - General Practice in South Portland, ME

Active since March 29, 2021
25 LONG CREEK DR UNIT D, SOUTH PORTLAND, ME 04106(207) 775-2072 Get Directions Write a Review

NPPES record last updated: March 29, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Breakwater Dental, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BREAKWATER DENTAL, LLC (NPI 1811575202) is a healthcare organization registered as a general practice in South Portland, Maine and active in the NPI registry since March 2021. The organization lists Shilo Annis, Owner/dentist, as its authorized official.

NPPES Registry Identity

NPI1811575202
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NameBREAKWATER DENTAL, LLC
Location Address25 LONG CREEK DR UNIT DSouth Portland, ME 04106-2440
Mailing Address5 Midnight LnGorham, ME 04038-2376 · (207) 272-9847
Phone(207) 775-2072
Organization SubpartNo
Authorized OfficialShilo AnnisOwner/dentist · (207) 272-9847
Enumeration DateMarch 29, 2021
NPPES CertifiedMarch 29, 2021
✔ NPI 1811575202 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
25 LONG CREEK DR UNIT D, South Portland, ME 04106
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Breakwater Dental, LLC's NPI number?

The NPI number for Breakwater Dental, LLC is 1811575202. It was assigned to this organization in the NPPES registry on March 29, 2021.

Where is Breakwater Dental, LLC located?

Breakwater Dental, LLC is located at 25 Long Creek Dr Unit D, South Portland, ME 04106. The listed phone number is (207) 775-2072.

What is Breakwater Dental, LLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Breakwater Dental, LLC was last updated on March 29, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.