Healthcare Provider Details

I. General information

NPI: 1215061882
Provider Name (Legal Business Name): LISA H. SLADE DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8607 2ND AVE SUITE 201A
SILVER SPRING MD
20910-3355
US

IV. Provider business mailing address

8607 2ND AVE SUITE 201A
SILVER SPRING MD
20910-3355
US

V. Phone/Fax

Practice location:
  • Phone: 301-585-9192
  • Fax: 301-585-9163
Mailing address:
  • Phone: 301-585-9192
  • Fax: 301-585-9163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number9660
License Number StateMD

VIII. Authorized Official

Name: DR. LISA SLADE
Title or Position: CEO-PRESIDENT
Credential:
Phone: 301-585-9192