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General NPI Number Information
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NPI Number | 1699208488
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Entity Type | Organization
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Legal Business Name | GREENVILLE TINY TEETH PLLC
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Dates
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Enumeration Date | 04/07/2017
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Last Update Date | 04/07/2017
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Provider Practice Location Address
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Address Line | 3206 I 30 SUITE C
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City | GREENVILLE
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State | TX
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Zip | 75402-7000
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Country | US
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Telephone | 469-207-0302
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Fax |
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Provider Business Mailing Address
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Address Line | 3206 I 30 SUITE C
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City | GREENVILLE
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State | TX
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Zip | 75402-7000
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Country | US
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Telephone | 469-207-0302
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. JAMES SLAUGHTER III
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Credential | DDS
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Telephone | 469-207-0302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 27169
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License Number State | TX
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