Individual
CODY KEVIN SLADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2081 1ST ST, ALAMOGORDO, NM 88310-5233
(575) 437-7900
Mailing address
5715 US HIGHWAY 93, JEROME, ID 83338-6780
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD5291
NM
Other
Enumeration date
07/09/2020
Last updated
07/09/2020
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