Provider Demographics
NPI:1629094768
Name:SLOTT, MARVIN MICHAEL (DDS ORAL SURGEON)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:MICHAEL
Last Name:SLOTT
Suffix:
Gender:M
Credentials:DDS ORAL SURGEON
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 NW 9 BLVD
Mailing Address - Street 2:#1
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605
Mailing Address - Country:US
Mailing Address - Phone:352-331-2016
Mailing Address - Fax:352-331-1676
Practice Address - Street 1:6801 NW 9 BLVD
Practice Address - Street 2:#1
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605
Practice Address - Country:US
Practice Address - Phone:352-331-2016
Practice Address - Fax:352-331-1676
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN5801204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
85255OtherBCBS
FL85255ZMedicare PIN
85255OtherBCBS