Healthcare Provider Details

I. General information

NPI: 1790716421
Provider Name (Legal Business Name): MARTIN W. SLOMINSKI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WINSTON-SALEM DENTAL CARE 201 CHARLOIS BLVD
WINSTON-SALEM NC
27103-1507
US

IV. Provider business mailing address

1140 FALLBROOK LN
LEWISVILLE NC
27023-8667
US

V. Phone/Fax

Practice location:
  • Phone: 336-718-1882
  • Fax: 336-718-1804
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6269
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: