Provider Demographics
NPI:1205652666
Name:SLATE FAMILY DENTISTRY
Entity type:Organization
Organization Name:SLATE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST/PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:AUSTIN
Authorized Official - Last Name:SLATE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-644-9649
Mailing Address - Street 1:1213 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LA FAYETTE
Mailing Address - State:GA
Mailing Address - Zip Code:30728-2136
Mailing Address - Country:US
Mailing Address - Phone:706-638-1114
Mailing Address - Fax:
Practice Address - Street 1:1213 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LA FAYETTE
Practice Address - State:GA
Practice Address - Zip Code:30728-2136
Practice Address - Country:US
Practice Address - Phone:706-638-1114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty