Provider Demographics
NPI:1265416515
Name:SLOUGH, DAVID L (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:SLOUGH
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 1:228 W HOSPITALITY LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3268
Mailing Address - Country:US
Mailing Address - Phone:909-891-3400
Mailing Address - Fax:909-891-3402
Practice Address - Street 1:228 W HOSPITALITY LN
Practice Address - Street 2:SUITE B
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3268
Practice Address - Country:US
Practice Address - Phone:909-891-3400
Practice Address - Fax:909-891-3402
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA254491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice