Healthcare Provider Details

I. General information

NPI: 1134587736
Provider Name (Legal Business Name): SLOVAN DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2016
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4427 S RURAL RD SUITE 2
TEMPE AZ
85282-7061
US

IV. Provider business mailing address

4427 S RURAL RD SUITE 2
TEMPE AZ
85282-7061
US

V. Phone/Fax

Practice location:
  • Phone: 480-897-2274
  • Fax:
Mailing address:
  • Phone: 480-897-2274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8919
License Number StateAZ

VIII. Authorized Official

Name: DR. JARED SLOVAN
Title or Position: OWNER
Credential: DMD
Phone: 843-810-5854