Provider Demographics
NPI:1598391054
Name:SLATER FAMILY DENTAL, PC
Entity Type:Organization
Organization Name:SLATER FAMILY DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SLATER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-649-5900
Mailing Address - Street 1:18540 SW VINCENT
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97078
Mailing Address - Country:US
Mailing Address - Phone:503-649-5900
Mailing Address - Fax:503-649-9047
Practice Address - Street 1:18540 SW VINCENT
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97078
Practice Address - Country:US
Practice Address - Phone:503-649-5900
Practice Address - Fax:503-649-9047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty