Provider Demographics
NPI:1780690412
Name:SLOW, IRA N (DMD)
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:N
Last Name:SLOW
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1825 BARNUM AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-5333
Mailing Address - Country:US
Mailing Address - Phone:203-375-6090
Mailing Address - Fax:203-375-6090
Practice Address - Street 1:1825 BARNUM AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-5333
Practice Address - Country:US
Practice Address - Phone:203-375-6090
Practice Address - Fax:203-375-6090
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT40711223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002040715Medicaid