Healthcare Provider Details

I. General information

NPI: 1629094768
Provider Name (Legal Business Name): MARVIN MICHAEL SLOTT DDS ORAL SURGEON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 NW 9 BLVD #1
GAINESVILLE FL
32605
US

IV. Provider business mailing address

6801 NW 9 BLVD #1
GAINESVILLE FL
32605
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 Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDN5801
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: