Provider Demographics
NPI:1043401458
Name:SLATER, MICAL CLAYTON (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICAL
Middle Name:CLAYTON
Last Name:SLATER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6768 SW 39TH CT
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-3202
Mailing Address - Country:US
Mailing Address - Phone:954-288-2948
Mailing Address - Fax:
Practice Address - Street 1:2929 N UNIVERSITY DR STE 203
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-1424
Practice Address - Country:US
Practice Address - Phone:954-288-2948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18120122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist