Provider Demographics
NPI:1871041442
Name:SLADKY FAMILY DENTISTRY
Entity Type:Organization
Organization Name:SLADKY FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SLADKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-227-0722
Mailing Address - Street 1:500 W SILVER SPRING DR STE K275
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-5062
Mailing Address - Country:US
Mailing Address - Phone:262-227-0722
Mailing Address - Fax:
Practice Address - Street 1:500 W SILVER SPRING DR STE K275
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-5062
Practice Address - Country:US
Practice Address - Phone:262-227-0722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty