Healthcare Provider Details

I. General information

NPI: 1386230266
Provider Name (Legal Business Name): SUSAN PAGE SLOAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CENTER DR RM D1-19
GAINESVILLE FL
32610-3006
US

IV. Provider business mailing address

15106 NW 149TH RD
ALACHUA FL
32615-0252
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-7846
  • Fax:
Mailing address:
  • Phone: 704-968-1025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH10875
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: