Provider Demographics
NPI:1366856700
Name:SLOAN, MADELINE GRACE (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:GRACE
Last Name:SLOAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:MADELINE
Other - Middle Name:GRACE
Other - Last Name:HELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:825 EUCLID AVE
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64124-2323
Mailing Address - Country:US
Mailing Address - Phone:816-889-4874
Mailing Address - Fax:816-889-1847
Practice Address - Street 1:10803 E 350 HWY
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64138-2313
Practice Address - Country:US
Practice Address - Phone:816-356-4008
Practice Address - Fax:816-358-4008
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20140179491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice