Healthcare Provider Details

I. General information

NPI: 1295779866
Provider Name (Legal Business Name): JOHN HENRY SLAVENS DDS,MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E 86TH ST SUITE 15
INDIANAPOLIS IN
46240-1868
US

IV. Provider business mailing address

4568 IVYWOOD CT
ZIONSVILLE IN
46077-9421
US

V. Phone/Fax

Practice location:
  • Phone: 317-844-3396
  • Fax: 317-844-4776
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number12009610A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: