Healthcare Provider Details

I. General information

NPI: 1790874881
Provider Name (Legal Business Name): STEVEN ROY SLAVKIN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 THONOTOSASSA RD
PLANT CITY FL
33563-2972
US

IV. Provider business mailing address

2005 THONOTOSASSA RD
PLANT CITY FL
33563-2972
US

V. Phone/Fax

Practice location:
  • Phone: 813-752-3555
  • Fax: 813-752-9274
Mailing address:
  • Phone: 813-752-3555
  • Fax: 813-752-9274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN 10835
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: