Provider Demographics
NPI:1649294224
Name:SLAVENS, JULIET ANNE (DDS)
Entity type:Individual
Prefix:DR
First Name:JULIET
Middle Name:ANNE
Last Name:SLAVENS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JULIET
Other - Middle Name:ANNE
Other - Last Name:SLAVENS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:311 E TYRANENA PARK RD
Mailing Address - Street 2:
Mailing Address - City:LAKE MILLS
Mailing Address - State:WI
Mailing Address - Zip Code:53551-9681
Mailing Address - Country:US
Mailing Address - Phone:920-648-2331
Mailing Address - Fax:920-648-3437
Practice Address - Street 1:311 E TYRANENA PARK RD
Practice Address - Street 2:
Practice Address - City:LAKE MILLS
Practice Address - State:WI
Practice Address - Zip Code:53551-9681
Practice Address - Country:US
Practice Address - Phone:920-648-2331
Practice Address - Fax:920-648-3437
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3647122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33489300Medicaid
WI38395300Medicaid