MEDICARE: DR. DAVID SLYBY D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	12010192	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134466279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID SLYBY D.D.S.

Provider Business Mailing Address
First Line	:	4606 EAST STATE BLVD
Second Line	:	B
City	:	FORT WAYNE
State	:	IN
Zip	:	46815
Country	:	US
Telephone Number	:	260-484-0725
Fax Number	:

Provider Business Practice Location Address
First Line	:	4606 E STATE BLVD
Second Line	:	B
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-6993
Country	:	US
Telephone Number	:	260-484-0725
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2013
Last Update Date	:	01/09/2013

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