Provider Demographics
NPI:1982134193
Name:SLUTSKIY, JEFF IGOR (DMD)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:IGOR
Last Name:SLUTSKIY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:IGOR
Other - Middle Name:YAKOV
Other - Last Name:SLUTSKIY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:4606 CEDAR SPRINGS RD APT 812
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-7204
Mailing Address - Country:US
Mailing Address - Phone:310-430-4823
Mailing Address - Fax:
Practice Address - Street 1:2049 SUNNYBROOK DRIVE
Practice Address - Street 2:
Practice Address - City:HEARTLAND
Practice Address - State:TN
Practice Address - Zip Code:75126
Practice Address - Country:US
Practice Address - Phone:972-287-5513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX330091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice