Provider Demographics
NPI:1568831857
Name:ACTON DENTAL, LLC
Entity Type:Organization
Organization Name:ACTON DENTAL, LLC
Other - Org Name:ACTONDENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:S
Authorized Official - Last Name:SLAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:636-226-5440
Mailing Address - Street 1:1871 W PEARCE BLVD
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3302
Mailing Address - Country:US
Mailing Address - Phone:636-327-5600
Mailing Address - Fax:636-332-5601
Practice Address - Street 1:1871 W PEARCE BLVD
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-3302
Practice Address - Country:US
Practice Address - Phone:636-327-5600
Practice Address - Fax:636-332-5601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050142381223G0001X
MO20080160641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty