Provider Demographics
NPI:1528554466
Name:SLOAN, CHAD SANDERS (MD, DDS)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:SANDERS
Last Name:SLOAN
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 RIVER PARK DR STE 360
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-5835
Mailing Address - Country:US
Mailing Address - Phone:801-362-9334
Mailing Address - Fax:
Practice Address - Street 1:280 RIVER PARK DR STE 360
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-5835
Practice Address - Country:US
Practice Address - Phone:801-437-7701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE34965204E00000X, 208600000X
UT13593976-1205208600000X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery