Provider Demographics
NPI:1750010153
Name:SLOMINSKI, JUSTIN NATHANIEL
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:NATHANIEL
Last Name:SLOMINSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4203 N HARTLEY AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-3305
Mailing Address - Country:US
Mailing Address - Phone:626-364-6742
Mailing Address - Fax:
Practice Address - Street 1:4203 N HARTLEY AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-3305
Practice Address - Country:US
Practice Address - Phone:626-364-6742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF2691521122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist