Provider Demographics
NPI:1982904868
Name:DRS MARK SLAVIN AND BRIAN JACKSON MARK SLAVIN GEN PTR
Entity type:Organization
Organization Name:DRS MARK SLAVIN AND BRIAN JACKSON MARK SLAVIN GEN PTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SLAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-724-5141
Mailing Address - Street 1:2534 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5814
Mailing Address - Country:US
Mailing Address - Phone:315-724-5141
Mailing Address - Fax:315-733-1270
Practice Address - Street 1:2534 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5814
Practice Address - Country:US
Practice Address - Phone:315-724-5141
Practice Address - Fax:315-733-1270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty