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General NPI Number Information
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NPI Number | 1821438425
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Entity Type | Individual
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Provider Name | JAY MICHAEL SLATER DMD
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Gender | Male
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Dates
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Enumeration Date | 06/27/2013
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Last Update Date | 11/24/2015
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Provider Practice Location Address
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Address Line | 8700 NE VANCOUVER MALL DR SUITE 202A
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City | VANCOUVER
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State | WA
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Zip | 98662-6750
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Country | US
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Telephone | 360-219-9616
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Fax |
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Provider Business Mailing Address
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Address Line | 2404 COLUMBIA HOUSE BLVD
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City | VANCOUVER
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State | WA
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Zip | 98661-7777
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Country | US
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Telephone | 360-746-3889
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D9879
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE60465783
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License Number State | WA
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