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General NPI Number Information
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NPI Number | 1467595504
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Entity Type | Organization
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Legal Business Name | BRENT D. SLOTEN D.O. PLLC
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 10/08/2019
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Provider Practice Location Address
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Address Line | 1818 E BASELINE RD BLDG. A
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City | MESA
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State | AZ
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Zip | 85204-6814
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Country | US
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Telephone | 480-981-1214
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Fax | 480-981-1625
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Provider Business Mailing Address
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Address Line | PO BOX 4880
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City | SCOTTSDALE
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State | AZ
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Zip | 85261-4880
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Country | US
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Telephone | 480-981-1214
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Fax | 480-981-1625
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. BRENT DREW SLOTEN
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Credential | D.O.
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Telephone | 480-981-1214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 3368
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License Number State | AZ
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