Provider Demographics
NPI:1497824668
Name:SLAUGHTER, JENNIFER ADDISON (DMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ADDISON
Last Name:SLAUGHTER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12607 BULLOCK GREENWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-8177
Mailing Address - Country:US
Mailing Address - Phone:704-708-8511
Mailing Address - Fax:
Practice Address - Street 1:3010 BAUCOM RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-0983
Practice Address - Country:US
Practice Address - Phone:704-596-0021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC82561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice