Provider Demographics
NPI:1346344884
Name:SLATTERY, JOHN C (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:SLATTERY
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Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:600 E RIVERPARK LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-6551
Mailing Address - Country:US
Mailing Address - Phone:208-433-1122
Mailing Address - Fax:208-433-1125
Practice Address - Street 1:600 E RIVERPARK LN
Practice Address - Street 2:SUITE 100
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-6551
Practice Address - Country:US
Practice Address - Phone:208-433-1122
Practice Address - Fax:208-433-1125
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDD-3500-OR1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics