Provider Demographics
NPI:1114789575
Name:DOLLARHIDE, SLADE
Entity Type:Individual
Prefix:
First Name:SLADE
Middle Name:
Last Name:DOLLARHIDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8794 GOODWATER RD
Mailing Address - Street 2:
Mailing Address - City:HAWORTH
Mailing Address - State:OK
Mailing Address - Zip Code:74740-5396
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8794 GOODWATER RD
Practice Address - Street 2:
Practice Address - City:HAWORTH
Practice Address - State:OK
Practice Address - Zip Code:74740-5396
Practice Address - Country:US
Practice Address - Phone:580-612-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0131124163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse