Provider Demographics
NPI:1386757169
Name:SLAGLE, THOMAS
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:SLAGLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BURDICK EXPY W
Mailing Address - Street 2:309
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-4498
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 BURDICK EXPY W
Practice Address - Street 2:309
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-4498
Practice Address - Country:US
Practice Address - Phone:701-839-2372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDND17101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND40897Medicaid