Provider Demographics
NPI:1073958583
Name:SLAUGHTER, TYLER W (DDS)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:W
Last Name:SLAUGHTER
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 1:905 FAIRMOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-3544
Mailing Address - Country:US
Mailing Address - Phone:573-353-2087
Mailing Address - Fax:
Practice Address - Street 1:3237 W TRUMAN BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-6944
Practice Address - Country:US
Practice Address - Phone:573-635-2571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013012180122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist