Provider Demographics
NPI:1992861249
Name:SLOCUM, CHAD GARRETT (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:GARRETT
Last Name:SLOCUM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12811 56TH PL W
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-5526
Mailing Address - Country:US
Mailing Address - Phone:425-337-7300
Mailing Address - Fax:425-337-7344
Practice Address - Street 1:3922 148TH ST SE
Practice Address - Street 2:SUITE 201
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012
Practice Address - Country:US
Practice Address - Phone:425-337-7300
Practice Address - Fax:425-337-7344
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00008388122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist