=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235476557
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELDON F SLOAN III DDS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2013
-----------------------------------------------------
Last Update Date | 01/07/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 CHURCH ST
-----------------------------------------------------
City | BROADWAY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27505-9394
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-258-6083
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 577
-----------------------------------------------------
City | BROADWAY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27505-0577
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ELDON F SLOAN III
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 919-258-9321
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 8400
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------