Provider Demographics
NPI:1699518720
Name:SLAGEL, SEBASTIAN R (DMD)
Entity type:Individual
Prefix:DR
First Name:SEBASTIAN
Middle Name:R
Last Name:SLAGEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 PROUTY DR STE 1
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-9455
Mailing Address - Country:US
Mailing Address - Phone:407-473-4330
Mailing Address - Fax:
Practice Address - Street 1:212 PROUTY DR STE 1
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-9455
Practice Address - Country:US
Practice Address - Phone:802-334-6965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.01342841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice