Provider Demographics
NPI:1144266222
Name:SLACK, CYNTHIA KATHRYN (DDS)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:KATHRYN
Last Name:SLACK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 BEAHAN ROAD
Mailing Address - Street 2:WESTGATE WOODS
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624
Mailing Address - Country:US
Mailing Address - Phone:585-426-2550
Mailing Address - Fax:585-426-4118
Practice Address - Street 1:523 BEAHAN ROAD
Practice Address - Street 2:WESTGATE WOODS
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624
Practice Address - Country:US
Practice Address - Phone:585-426-2550
Practice Address - Fax:585-426-4118
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035772122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist