Provider Demographics
NPI:1467595504
Name:BRENT D. SLOTEN D.O. PLLC
Entity Type:Organization
Organization Name:BRENT D. SLOTEN D.O. PLLC
Other - Org Name:ALLURE DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:DREW
Authorized Official - Last Name:SLOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-981-1214
Mailing Address - Street 1:PO BOX 4880
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85261-4880
Mailing Address - Country:US
Mailing Address - Phone:480-981-1214
Mailing Address - Fax:480-981-1625
Practice Address - Street 1:1818 E BASELINE RD
Practice Address - Street 2:BLDG. A
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6814
Practice Address - Country:US
Practice Address - Phone:480-981-1214
Practice Address - Fax:480-981-1625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3368261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3368OtherMEDICAL LICENSE
AZ1073585402OtherPERSONAL NPI
AZ1073585402OtherPERSONAL NPI