Provider Demographics
NPI:1184700320
Name:SLOAN, ELDON F JR
Entity type:Individual
Prefix:DR
First Name:ELDON
Middle Name:F
Last Name:SLOAN
Suffix:JR
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:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:BROADWAY
Mailing Address - State:NC
Mailing Address - Zip Code:27505
Mailing Address - Country:US
Mailing Address - Phone:919-258-9321
Mailing Address - Fax:919-258-9741
Practice Address - Street 1:103 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:BROADWAY
Practice Address - State:NC
Practice Address - Zip Code:27505
Practice Address - Country:US
Practice Address - Phone:919-258-9321
Practice Address - Fax:919-258-9741
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8997843Medicaid
NC97843OtherBLUE CROSS BLUE SHIELD