Healthcare Provider Details

I. General information

NPI: 1215482310
Provider Name (Legal Business Name): JOHNATHAN A SLATE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 07/27/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 NEW MEXICO AVE NW STE 332
WASHINGTON DC
20016-3623
US

IV. Provider business mailing address

3301 NEW MEXICO AVE NW STE 332
WASHINGTON DC
20016-3623
US

V. Phone/Fax

Practice location:
  • Phone: 202-686-5222
  • Fax:
Mailing address:
  • Phone: 202-686-5222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN1001655
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: