Provider Demographics
NPI:1427134121
Name:SLAGLE, JAMES LESTER JR (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LESTER
Last Name:SLAGLE
Suffix:JR
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 1:9 HOLLY HILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-2559
Mailing Address - Country:US
Mailing Address - Phone:804-733-9490
Mailing Address - Fax:804-733-3564
Practice Address - Street 1:9 HOLLY HILL DRIVE
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805
Practice Address - Country:US
Practice Address - Phone:804-733-9490
Practice Address - Fax:804-733-3564
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010056531223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
S41005832Medicare UPIN