Healthcare Provider Details

I. General information

NPI: 1679654610
Provider Name (Legal Business Name): RICHARD LOWELL SLATE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 CHAPEL HILL MALL 2000 BRITTAIN RD AMERICAN DENTAL CENTERS
AKRON OH
44310
US

IV. Provider business mailing address

6140 PARKLAND BLVD STE 100 AMERICAN DENTAL CENTERS
MAYFIELD HTS OH
44124
US

V. Phone/Fax

Practice location:
  • Phone: 330-630-9222
  • Fax: 330-630-2339
Mailing address:
  • Phone: 440-446-1555
  • Fax: 440-446-1990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number13982
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: