Provider Demographics
NPI:1659447571
Name:SLOAN, LUCY BURGIN (DENTIST)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:BURGIN
Last Name:SLOAN
Suffix:
Gender:F
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 WALDRON ROAD
Mailing Address - Street 2:
Mailing Address - City:LAVERGNE
Mailing Address - State:TN
Mailing Address - Zip Code:37086
Mailing Address - Country:US
Mailing Address - Phone:615-793-4499
Mailing Address - Fax:615-793-3124
Practice Address - Street 1:379 WALDRON RD
Practice Address - Street 2:
Practice Address - City:LAVERGNE
Practice Address - State:TN
Practice Address - Zip Code:37086
Practice Address - Country:US
Practice Address - Phone:615-793-4499
Practice Address - Fax:615-793-3124
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
TNTN7189122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist