Healthcare Provider Details

I. General information

NPI: 1477602605
Provider Name (Legal Business Name): PETER SLEPSKY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24023 FAIRVIEW RD
CAPE CHARLES VA
23310-2153
US

IV. Provider business mailing address

1265 HEBDEN CV
VIRGINIA BEACH VA
23452-4607
US

V. Phone/Fax

Practice location:
  • Phone: 757-331-6004
  • Fax:
Mailing address:
  • Phone: 757-486-8047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401008191
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: