Provider Demographics
NPI:1346383098
Name:SLAMAT, JIMMY S (DDS)
Entity Type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:S
Last Name:SLAMAT
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 1:600 W 9TH ST
Mailing Address - Street 2:#216
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-4301
Mailing Address - Country:US
Mailing Address - Phone:213-842-5489
Mailing Address - Fax:213-622-0540
Practice Address - Street 1:607 W 6TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3201
Practice Address - Country:US
Practice Address - Phone:213-624-6482
Practice Address - Fax:213-624-8483
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48023122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist