Provider Demographics
NPI:1619102019
Name:SLATER, RODNEY JOHN (DMD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:JOHN
Last Name:SLATER
Suffix:
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 1:5540 W PISA LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-4805
Mailing Address - Country:US
Mailing Address - Phone:801-722-8211
Mailing Address - Fax:575-586-0519
Practice Address - Street 1:5540 W PISA LN
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-4805
Practice Address - Country:US
Practice Address - Phone:801-722-8211
Practice Address - Fax:575-586-0519
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2023-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5686807-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist