MEDICARE: DR. CHARLES TORRY SLAUGHTER III DMD

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	1223G0001X	General Practice Dentistry	5548	FL

General Provider Information

NPI Number	:	1184637597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES TORRY SLAUGHTER III DMD

Provider Business Mailing Address
First Line	:	856 W PLYMOUTH AVE
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32720-3284
Country	:	US
Telephone Number	:	386-734-5615
Fax Number	:	386-736-7437

Provider Business Practice Location Address
First Line	:	856 W PLYMOUTH AVE
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32720-3284
Country	:	US
Telephone Number	:	386-734-5615
Fax Number	:	386-736-7437

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	07/08/2007

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