Organization
NORTHSIDE ENDODONTICS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN H SLAVENS DDS,MSD (OWNER)
(795) 759-9630
Entity
Organization
Contact information
Practice address
1400 S PILGRIM BLVD, YORKTOWN, IN 47396-9250
(765) 759-9630
(765) 759-9640
Mailing address
1400 S PILGRIM BLVD, YORKTOWN, IN 47396-9250
(765) 759-9630
(765) 759-9640
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
54000837A
IN
Other
Enumeration date
08/18/2008
Last updated
08/18/2008
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