Provider Demographics
NPI:1265586242
Name:SLATTERY, JIM (DDS)
Entity type:Individual
Prefix:DR
First Name:JIM
Middle Name:
Last Name:SLATTERY
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:PO BOX 576
Mailing Address - Street 2:
Mailing Address - City:ELK POINT
Mailing Address - State:SD
Mailing Address - Zip Code:57025-0576
Mailing Address - Country:US
Mailing Address - Phone:605-356-2271
Mailing Address - Fax:
Practice Address - Street 1:109 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:ELK POINT
Practice Address - State:SD
Practice Address - Zip Code:57025-0576
Practice Address - Country:US
Practice Address - Phone:605-356-2271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM-3431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice