Provider Demographics
NPI:1730570185
Name:ANGLEA SLONE DMD PC
Entity type:Organization
Organization Name:ANGLEA SLONE DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGLEA
Authorized Official - Middle Name:SLONE
Authorized Official - Last Name:RASMUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-495-9004
Mailing Address - Street 1:9590 MEDLOCK BRIDGE RD
Mailing Address - Street 2:STE D
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4443
Mailing Address - Country:US
Mailing Address - Phone:770-495-9004
Mailing Address - Fax:770-495-1422
Practice Address - Street 1:9590 MEDLOCK BRIDGE RD
Practice Address - Street 2:STE D
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4443
Practice Address - Country:US
Practice Address - Phone:770-495-9004
Practice Address - Fax:770-495-1422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN011450261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental