Healthcare Provider Details

I. General information

NPI: 1235209487
Provider Name (Legal Business Name): JODI A SLOMINSKY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 CRAIG RD
EAU CLAIRE WI
54701-6186
US

IV. Provider business mailing address

1035 WILLOW GREEN CIR
EAU CLAIRE WI
54701-7014
US

V. Phone/Fax

Practice location:
  • Phone: 715-552-7227
  • Fax:
Mailing address:
  • Phone: 715-831-8875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5005
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: