Basic Information
| Provider Information | |||||||||
| NPI: | 1669894705 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SLA DENTAL PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1225 E 1ST ST | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558052402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187286445 | ||||||||
| FaxNumber: | 2187247003 | ||||||||
| Practice Location | |||||||||
| Address1: | 1225 E 1ST ST | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558052402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187286445 | ||||||||
| FaxNumber: | 2187247003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2014 | ||||||||
| LastUpdateDate: | 01/16/2014 | ||||||||
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| AuthorizedOfficialLastName: | AMADIO | ||||||||
| AuthorizedOfficialFirstName: | SETH | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2187286445 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | D12809 | MN | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.