Provider Demographics
NPI:1255174108
Name:SLATER, MADELINE DEBRA (DDS)
Entity type:Individual
Prefix:DR
First Name:MADELINE
Middle Name:DEBRA
Last Name:SLATER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 GRYN CT
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-4440
Mailing Address - Country:US
Mailing Address - Phone:641-251-4678
Mailing Address - Fax:
Practice Address - Street 1:1557 W 84TH AVE # 1
Practice Address - Street 2:
Practice Address - City:FEDERAL HEIGHTS
Practice Address - State:CO
Practice Address - Zip Code:80260-4780
Practice Address - Country:US
Practice Address - Phone:303-426-4860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00206044122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist