Individual
ETHAN W SLATER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10 MISSILE AVE, MINOT AFB, ND 58705-5003
(719) 333-5192
Mailing address
10 MISSILE AVE, MINOT AFB, ND 58705-5003
(719) 231-8122
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DEN.00205630
CO
Other
Enumeration date
03/13/2023
Last updated
09/06/2024
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