Provider Demographics
NPI:1154419265
Name:SLAUGHTER, JOHN HARRISON III (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HARRISON
Last Name:SLAUGHTER
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 W CRONLY ST
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-3652
Mailing Address - Country:US
Mailing Address - Phone:910-277-0661
Mailing Address - Fax:910-276-8342
Practice Address - Street 1:411 W CRONLY ST
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-3652
Practice Address - Country:US
Practice Address - Phone:910-277-0661
Practice Address - Fax:910-276-8342
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC45371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-97841Medicaid
NCU36915Medicare UPIN