Provider Demographics
NPI:1619043585
Name:SLAGLE, MEAD L (DDS)
Entity Type:Individual
Prefix:
First Name:MEAD
Middle Name:L
Last Name:SLAGLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 967
Mailing Address - Street 2:
Mailing Address - City:BUXTON
Mailing Address - State:NC
Mailing Address - Zip Code:27920
Mailing Address - Country:US
Mailing Address - Phone:252-995-4101
Mailing Address - Fax:252-995-4423
Practice Address - Street 1:50716 HWY 12
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:NC
Practice Address - Zip Code:27936
Practice Address - Country:US
Practice Address - Phone:252-995-4101
Practice Address - Fax:252-995-4423
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6725122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC90057OtherBCBS
NC971567OtherTRICARE UNITED CONCORDIA