Provider Demographics
NPI:1871684829
Name:SLATTERY, DOROTHY J (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:J
Last Name:SLATTERY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 E BLITHEDALE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-1478
Mailing Address - Country:US
Mailing Address - Phone:415-388-6006
Mailing Address - Fax:415-388-7138
Practice Address - Street 1:650 E BLITHEDALE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-1478
Practice Address - Country:US
Practice Address - Phone:415-388-6006
Practice Address - Fax:415-388-7138
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA342161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice