Healthcare Provider Details

I. General information

NPI: 1457273583
Provider Name (Legal Business Name): ROSCOE WILLIAM DEAN SLACK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 W 27TH ST
CEDAR FALLS IA
50614-0012
US

IV. Provider business mailing address

1227 W 27TH ST
CEDAR FALLS IA
50614-0012
US

V. Phone/Fax

Practice location:
  • Phone: 319-273-2311
  • Fax:
Mailing address:
  • Phone: 319-273-2311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: