Individual
CASEY M. SLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
4881 SUGAR MAPLE DR, DAYTON, OH 45433
(937) 257-0500
Mailing address
1065 BOSTON ROAD, JOINT BASE ANDREWS, MD 20762
(240) 857-5029
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
0401413693
VA
1223G0001X
General Practice Dentistry
Primary
0401413693
VA
390200000X
Student in an Organized Health Care Education/Training Program
0442000128
VA
Other
Enumeration date
06/07/2010
Last updated
10/07/2024
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