Healthcare Provider Details

I. General information

NPI: 1750389433
Provider Name (Legal Business Name): MICHAEL J SLOAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 E MAIN ST SUITE 5
EAST ISLIP NY
11730-2600
US

IV. Provider business mailing address

10 FIELDHOUSE AVE
E SETAUKET NY
11733-1038
US

V. Phone/Fax

Practice location:
  • Phone: 631-581-8888
  • Fax: 631-581-8139
Mailing address:
  • Phone: 631-581-8888
  • Fax: 631-581-8139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number044123
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: