Provider Demographics
NPI:1093872418
Name:SLATTERY, MICHAEL THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:SLATTERY
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 1:18440 NORTH 7TH ST.
Mailing Address - Street 2:SUITE # 10
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-1177
Mailing Address - Country:US
Mailing Address - Phone:602-866-2102
Mailing Address - Fax:602-866-0046
Practice Address - Street 1:18440 N 7TH ST
Practice Address - Street 2:SUITE # 10
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-1125
Practice Address - Country:US
Practice Address - Phone:602-866-2102
Practice Address - Fax:602-866-0046
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice