Provider Demographics
NPI:1538338439
Name:MARVIN SLOTT DDS PA
Entity type:Organization
Organization Name:MARVIN SLOTT DDS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-331-2016
Mailing Address - Street 1:6801 NW 9TH BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4263
Mailing Address - Country:US
Mailing Address - Phone:352-331-2016
Mailing Address - Fax:352-331-1676
Practice Address - Street 1:6801 NW 9TH BLVD STE 1
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4263
Practice Address - Country:US
Practice Address - Phone:352-331-2016
Practice Address - Fax:352-331-1676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN58011223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL074111600OtherMEDICAID
FL85255OtherBCBSFL
FL85255OtherBCBSFL
T84602Medicare UPIN