Provider Demographics
NPI:1235290172
Name:SLOTNICK, STEPHEN RONALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:RONALD
Last Name:SLOTNICK
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 1:8307 DELPHIAN DR
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-2517
Mailing Address - Country:US
Mailing Address - Phone:925-813-0456
Mailing Address - Fax:
Practice Address - Street 1:1702 PAT BOOKER RD
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-3435
Practice Address - Country:US
Practice Address - Phone:210-907-8362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA267051223G0001X
TX270181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty