Healthcare Provider Details

I. General information

NPI: 1538338439
Provider Name (Legal Business Name): MARVIN SLOTT DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 04/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 NW 9TH BLVD STE 1
GAINESVILLE FL
32605-4263
US

IV. Provider business mailing address

6801 NW 9TH BLVD STE 1
GAINESVILLE FL
32605-4263
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-2016
  • Fax: 352-331-1676
Mailing address:
  • Phone: 352-331-2016
  • Fax: 352-331-1676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN5801
License Number StateFL

VIII. Authorized Official

Name: MARVIN SLOTT
Title or Position: PRESIDENT
Credential:
Phone: 352-331-2016