Healthcare Provider Details

I. General information

NPI: 1801839469
Provider Name (Legal Business Name): DR. ANDREW SLAVIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 N FLAGLER DR SUITE 5200
WEST PALM BEACH FL
33401-3404
US

IV. Provider business mailing address

1411 N FLAGLER DR SUITE 5200
WEST PALM BEACH FL
33401-3404
US

V. Phone/Fax

Practice location:
  • Phone: 561-833-6880
  • Fax: 561-833-1924
Mailing address:
  • Phone: 561-833-6880
  • Fax: 561-833-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberDN9729
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: