Provider Demographics
NPI:1568825461
Name:CORSICANA PEDIATRIC DENTISTRY, PA
Entity Type:Organization
Organization Name:CORSICANA PEDIATRIC DENTISTRY, PA
Other - Org Name:CORSICANA PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SLAUGHTER
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-288-8881
Mailing Address - Street 1:842 W 7TH AVE
Mailing Address - Street 2:STE C
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-6318
Mailing Address - Country:US
Mailing Address - Phone:225-788-8881
Mailing Address - Fax:
Practice Address - Street 1:842 W 7TH AVE
Practice Address - Street 2:STE C
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-6318
Practice Address - Country:US
Practice Address - Phone:225-288-8881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX271691223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty