Healthcare Provider Details

I. General information

NPI: 1588697593
Provider Name (Legal Business Name): TERRY W. SLAUGHTER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

328 JEFFERSON AVE # B
CLIFTON FORGE VA
24422-1749
US

IV. Provider business mailing address

328 JEFFERSON AVE # B
CLIFTON FORGE VA
24422-1749
US

V. Phone/Fax

Practice location:
  • Phone: 540-862-4495
  • Fax: 540-862-3684
Mailing address:
  • Phone: 540-862-4495
  • Fax: 540-862-3684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberVA5319
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: