Provider Demographics
NPI:1194820878
Name:SLACK, CALE (DDS)
Entity Type:Individual
Prefix:
First Name:CALE
Middle Name:
Last Name:SLACK
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 1:2425 W 57TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5026
Mailing Address - Country:US
Mailing Address - Phone:605-339-2040
Mailing Address - Fax:605-339-4441
Practice Address - Street 1:2425 W 57TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5026
Practice Address - Country:US
Practice Address - Phone:605-339-2040
Practice Address - Fax:605-339-4441
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM8741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice