Provider Demographics
NPI:1376648493
Name:SLAYTON, REBECCA LYNN (DDS, PHD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:LYNN
Last Name:SLAYTON
Suffix:
Gender:F
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 E ROANOKE ST
Mailing Address - Street 2:UNIT 7
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3243
Mailing Address - Country:US
Mailing Address - Phone:319-855-3441
Mailing Address - Fax:
Practice Address - Street 1:6222 NE 74TH ST # 354915
Practice Address - Street 2:THE CENTER FOR PEDIATRIC DENTISTRY
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-8158
Practice Address - Country:US
Practice Address - Phone:206-543-6141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000098831223P0221X
IA075871223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5050562Medicaid
ID807451900Medicaid
MT0130067Medicaid
AKDD481WAMedicaid