Provider Demographics
NPI:1184637597
Name:SLAUGHTER, CHARLES TORRY III (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:TORRY
Last Name:SLAUGHTER
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 W PLYMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-3284
Mailing Address - Country:US
Mailing Address - Phone:386-734-5615
Mailing Address - Fax:386-736-7437
Practice Address - Street 1:856 W PLYMOUTH AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-3284
Practice Address - Country:US
Practice Address - Phone:386-734-5615
Practice Address - Fax:386-736-7437
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL55481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice