Provider Demographics
NPI:1942212246
Name:SLATON, C CORNELIOUS
Entity Type:Individual
Prefix:DR
First Name:C
Middle Name:CORNELIOUS
Last Name:SLATON
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 1:3459 ACWORTH DUE WEST RD NW
Mailing Address - Street 2:SUITE 305
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-5819
Mailing Address - Country:US
Mailing Address - Phone:770-975-0175
Mailing Address - Fax:770-975-7294
Practice Address - Street 1:3459 ACWORTH DUE WEST RD NW
Practice Address - Street 2:SUITE 305
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-5819
Practice Address - Country:US
Practice Address - Phone:770-975-0175
Practice Address - Fax:770-975-7294
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0106091223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics