Provider Demographics
NPI:1568467538
Name:SLADE, EDWIN W JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:W
Last Name:SLADE
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PROGRESS DR
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-2563
Mailing Address - Country:US
Mailing Address - Phone:215-345-7373
Mailing Address - Fax:215-345-0242
Practice Address - Street 1:101 PROGRESS DR
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-2563
Practice Address - Country:US
Practice Address - Phone:215-345-7373
Practice Address - Fax:215-345-0242
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018340L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT27614Medicare UPIN
PA051516Medicare ID - Type Unspecified