Provider Demographics
NPI:1457561672
Name:JEFFREY R. SLOTTEN
Entity Type:Organization
Organization Name:JEFFREY R. SLOTTEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:SLOTTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:386-328-1500
Mailing Address - Street 1:205 ZEAGLER DR
Mailing Address - Street 2:SUITE 502
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-3888
Mailing Address - Country:US
Mailing Address - Phone:386-328-1500
Mailing Address - Fax:382-328-1179
Practice Address - Street 1:205 ZEAGLER DR
Practice Address - Street 2:SUITE 502
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3888
Practice Address - Country:US
Practice Address - Phone:386-328-1500
Practice Address - Fax:382-328-1179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN10163261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental