Provider Demographics
NPI:1164641031
Name:SHLAFSTEIN, MICHAEL (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SHLAFSTEIN
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 1:351 MERLINE RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4040
Mailing Address - Country:US
Mailing Address - Phone:860-875-5664
Mailing Address - Fax:860-875-0520
Practice Address - Street 1:351 MERLINE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4040
Practice Address - Country:US
Practice Address - Phone:860-875-5664
Practice Address - Fax:860-875-0520
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT84971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice