Provider Demographics
NPI:1093915530
Name:SLAUGHTER, TERRY W. SLAUGHTER W (DDS MSD)
Entity Type:Individual
Prefix:DR
First Name:TERRY W. SLAUGHTER
Middle Name:W
Last Name:SLAUGHTER
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
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Mailing Address - Street 1:901 SUNSET DR
Mailing Address - Street 2:STE 5
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-5613
Mailing Address - Country:US
Mailing Address - Phone:831-636-8484
Mailing Address - Fax:831-636-8244
Practice Address - Street 1:901 SUNSET DR
Practice Address - Street 2:STE 5
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5613
Practice Address - Country:US
Practice Address - Phone:831-636-8484
Practice Address - Fax:831-636-8244
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA160531223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA16053OtherDENTAL LICENSE
CADS160531OtherMEDICARE
CADS160531OtherMEDICARE