MEDICARE: LISA A. SLAUGHTER, DMD,PLLC

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	DEN4089	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1003003633	OTHER	NH	NPPES

General Provider Information

NPI Number	:	1215313424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LISA A. SLAUGHTER, DMD,PLLC

Provider Business Mailing Address
First Line	:	62 PORTLAND RD STE 41
Second Line	:
City	:	KENNEBUNK
State	:	ME
Zip	:	04043-6650
Country	:	US
Telephone Number	:	207-985-3444
Fax Number	:

Provider Business Practice Location Address
First Line	:	62 PORTLAND RD STE 41
Second Line	:
City	:	KENNEBUNK
State	:	ME
Zip	:	04043-6650
Country	:	US
Telephone Number	:	207-985-3444
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. LISA SLAUGHTER
Credential	:	D.M.D.
Telephone Number	:	207-985-3444

Provider Enumeration Date	:	08/11/2015
Last Update Date	:	08/11/2015

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