Provider Demographics
NPI:1073602322
Name:SLAVEN, GARY KYLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:KYLE
Last Name:SLAVEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 S POST OAK RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-5200
Mailing Address - Country:US
Mailing Address - Phone:337-625-0008
Mailing Address - Fax:
Practice Address - Street 1:1215 S POST OAK RD
Practice Address - Street 2:SUITE 7
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-5200
Practice Address - Country:US
Practice Address - Phone:337-625-0008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA55071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice