Provider Demographics
NPI:1942409347
Name:SLOAN, MICHAEL SHANE (DMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SHANE
Last Name:SLOAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1741 GOLD HILL RD
Mailing Address - Street 2:SUITE 2010
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8202
Mailing Address - Country:US
Mailing Address - Phone:803-548-3342
Mailing Address - Fax:803-548-3817
Practice Address - Street 1:1741 GOLD HILL RD
Practice Address - Street 2:SUITE 2010
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8202
Practice Address - Country:US
Practice Address - Phone:803-548-3342
Practice Address - Fax:803-548-3817
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice