Doctor Name: | CASEY M. SLACK |
NPI Number: | 1477873040 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DDS |
License Number: | 0442000128 |
Business Practice Address: | 18th Medical Group Unit 5270 Apo, AP - 96368 |
Business Phone Number: | 09082940563 |
Business Fax Number: | |
Mailing Address: | Psc 80 Box 11072, APO |
State: | AP |
Postal Code: | 963670013 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 06/07/2010 |
NPI Last Update Date: | 05/01/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 0442000128 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | VA |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |