Provider Demographics
NPI:1285967521
Name:SLIGHLY, BRIAN COREY (DDS)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:COREY
Last Name:SLIGHLY
Suffix:
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 1:1585 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-9103
Mailing Address - Country:US
Mailing Address - Phone:269-207-0607
Mailing Address - Fax:
Practice Address - Street 1:11828 RING DR STE 102
Practice Address - Street 2:
Practice Address - City:MANOR
Practice Address - State:TX
Practice Address - Zip Code:78653-2106
Practice Address - Country:US
Practice Address - Phone:512-649-3339
Practice Address - Fax:512-243-6838
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020111122300000X, 1223P0700X
TX29788122300000X, 1223G0001X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice