Provider Demographics
NPI:1841695392
Name:SLOCUM, ELIZABETH (DMD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SLOCUM
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 1:179 PINE GROVE RD STE A
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-8490
Mailing Address - Country:US
Mailing Address - Phone:770-387-0750
Mailing Address - Fax:770-387-0797
Practice Address - Street 1:179 PINE GROVE RD STE A
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-8490
Practice Address - Country:US
Practice Address - Phone:770-387-0750
Practice Address - Fax:770-387-0797
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA112891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice