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Organization
SLADE DMD CORPORATION
Active
Organization
SLADE DMD CORPORATION
Active
Other names
Peach Tree Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TROY KENDALL SLADE D.M.D. (DENTIST/OWNER)
(805) 544-7804
Entity
Organization
Contact information
Practice address
862 MEINECKE AVENUE, SUITE 200, SAN LUIS OBISPO, CA 93405
(805) 544-7804
(805) 544-6020
Mailing address
862 MEINECKE AVENUE, SUITE 200, SAN LUIS OBISPO, CA 93405
(805) 544-7804
(805) 544-6020
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
58800
CA
1223G0001X
General Practice Dentistry
62898
CA
Other
Enumeration date
04/13/2007
Last updated
08/04/2014
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