Provider Demographics
NPI:1356713242
Name:DR ANDREW SLODOV DDS MSD
Entity type:Organization
Organization Name:DR ANDREW SLODOV DDS MSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRANDEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-963-5905
Mailing Address - Street 1:8848 COMMONS BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087
Mailing Address - Country:US
Mailing Address - Phone:216-346-5986
Mailing Address - Fax:
Practice Address - Street 1:8848 COMMONS BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087
Practice Address - Country:US
Practice Address - Phone:216-346-5986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300186551223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty