Healthcare Provider Details

I. General information

NPI: 1730652397
Provider Name (Legal Business Name): SLETTO DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 S NATIONAL AVE
SPRINGFIELD MO
65807-7309
US

IV. Provider business mailing address

3540 S NATIONAL AVE
SPRINGFIELD MO
65807-7309
US

V. Phone/Fax

Practice location:
  • Phone: 417-886-9094
  • Fax:
Mailing address:
  • Phone: 417-886-9094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY E SLETTO JR.
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 417-886-9094