Healthcare Provider Details

I. General information

NPI: 1033368584
Provider Name (Legal Business Name): TROY KENDALL SLADE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 S TONOPAH DR STE. 200
LAS VEGAS NV
89106-4043
US

IV. Provider business mailing address

PO BOX 539 STE. 200
SANTA YNEZ CA
93460-0539
US

V. Phone/Fax

Practice location:
  • Phone: 702-435-5015
  • Fax: 702-366-1483
Mailing address:
  • Phone: 805-688-7070
  • Fax: 805-686-2060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5731
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: