Provider Demographics
NPI:1285493148
Name:SLATE, LINDSEY (RDH)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:SLATE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5017 THICKET LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-1512
Mailing Address - Country:US
Mailing Address - Phone:910-514-3709
Mailing Address - Fax:
Practice Address - Street 1:220 W CONGRESS STREET
Practice Address - Street 2:FLOOR 2
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226
Practice Address - Country:US
Practice Address - Phone:910-514-3709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902020694124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist