SLADE DMD CORPORATION (NPI# 1750506036) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750506036 |
| Entity Type | Organization |
| Organization Name | SLADE DMD CORPORATION |
| Other Organization Name | PEACH TREE DENTAL |
| Practice Address |
862 Meinecke Avenue Suite 200 San Luis Obispo CA 93405 |
| Practice Telephone | 8055447804 |
| Practice Fax Number | 8055446020 |
| Mailing Telephone | 8055447804 |
| Mailing Fax Number | 8055446020 |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2014-08-04 |
| Authorized Official Name | MR. TROY KENDALL SLADE (DENTIST/OWNER) |
| Authorized Official Telephone | 8055447804 |
| Authorized Official Credential | D.M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223G0001X |
Dentist Specialization: General Practice |
62898 | CA | Dental Providers |
| Y | 1223G0001X |
Dentist Specialization: General Practice |
58800 | CA | Dental Providers |
| Other Name | Type Code |
|---|---|
| Peach Tree Dental | Doing Business As Name - Organization |
| Street Address |
862 MEINECKE AVENUE SUITE 200 |
| City | SAN LUIS OBISPO |
| State | CA |
| Zip Code | 93405 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164076626 | Hilary Abbott Anderson | Physician Assistant | 127 Casa St., San Luis Obispo, CA 93405 | 2019-08-01 |
| 1811465834 | Fatemeh Ladan Ahmadinia | Dentist | 764 N Santa Rosa St, San Luis Obispo, CA 93405 | 2018-11-07 |
| 1538559794 | Arnold Martin Horwitz | Marriage & Family Therapist | 1605 Garnette Drive, San Luis Obispo, CA 93405 | 2015-01-27 |
| 1750794764 | Solmaz Naghsh | Pharmacist | 765 Foothill Blvd, San Luis Obispo, CA 93405 | 2014-06-06 |
| 1609293471 | Robert S. Flores Dmd, Inc | Dentist | 878 Boysen Avenue, San Luis Obispo, CA 93405 | 2014-03-18 |
| 1457776445 | Laura Anne Wilvert | Marriage & Family Therapist | 793 E. Foothill Blvd, Suite A, #278, San Luis Obispo, CA 93405 | 2014-02-27 |
| 1497181200 | Tracey Ruby Madrigal | Counselor | 1106 Oceanaire Dr. #25, San Luis Obispo, CA 93405 | 2013-09-25 |
| 1437597572 | Sarah Michelle Brenis | Counselor | 524 Princeton Place, San Luis Obispo, CA 93405 | 2013-06-11 |
| 1013350974 | Jenna Rose Ramos | Counselor | 1459 Descanso St., San Luis Obispo, CA 93405 | 2013-04-10 |
| 1700140696 | Christopher Dieterich Marchand | Social Worker | 793a E. Foothill Blvd, 190, San Luis Obispo, CA 93405 | 2012-06-26 |
| Find all providers in zip 93405 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811465834 | Fatemeh Ladan Ahmadinia | Dentist | 764 N Santa Rosa St, San Luis Obispo, CA 93405 | 2018-11-07 |
| 1649593237 | Erlinda Carrie Ramirez | Dentist | 1250 Peach Street Suite G, San Luis Obispo, CA 93401 | 2010-03-10 |
| 1831389105 | Dwight Carvalho | Dentist | California Mens Colony Cdcr, Hwy 1, San Luis Obispo, CA 93409-0001 | 2007-08-01 |
| 1982814968 | Jason Christopher Leroux | Dentist | 225 N Santa Rosa St, San Luis Obispo, CA 93405-1324 | 2007-05-22 |
| 1811105927 | Paul Richard Cavigli | Dentist | 688 California Blvd, Ste A, San Luis Obispo, CA 93401-2560 | 2007-05-21 |
| 1235342601 | Ronald J Barbieri | Dentist | 1131 Pacific St, San Luis Obispo, CA 93401-3301 | 2007-05-08 |
| 1144342692 | Ernest George Beccacio | Dentist | 100 Colony Rd, San Luis Obispo, CA 93409-1000 | 2007-04-04 |
| 1972622041 | Ryan M Ross | Dentist | 11545 Los Osos Valley Rd Ste A, San Luis Obispo, CA 93405-6470 | 2007-03-28 |
| 1376661629 | Ron Brunick | Dentist | 956 Walnut St, Suite 300, San Luis Obispo, CA 93401-1707 | 2007-03-26 |
| 1144345877 | Rodney Scot Hiltbrand | Dentist | 1340 Santa Rosa St, San Luis Obispo, CA 93401-3716 | 2007-03-20 |
| Find all providers in SAN LUIS OBISPO | ||||
| City | SAN LUIS OBISPO |
| Zip Code | 93405 |
Please comment or provide details below to improve the information on SLADE DMD CORPORATION.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.