SLADE DMD CORPORATION NPI 1750506036

NPI Information

  • NPI: 1750506036
  • Provider Name: SLADE DMD CORPORATION
  • Classification: Dentist - 1223G0001X
  • Specialization: General Practice
  • Entity Type: Organization
  • Doing Business As: PEACH TREE DENTAL
  • Address: 862 MEINECKE AVENUE
    SUITE 200
    SAN LUIS OBISPO, CA
    ZIP 93405
  • Phone: (805) 544-7804

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NPI Details

SLADE DMD CORPORATION is a general practice dentist in San Luis Obispo, CA. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. SLADE DMD CORPORATION NPI is 1750506036. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Peach Tree Dental.

The provider's business location address is:

862 MEINECKE AVENUE
SUITE 200
SAN LUIS OBISPO, CA
ZIP 93405
Phone: (805) 544-7804
Fax: (805) 544-6020

The provider's authorized official is Troy Kendall Slade .
The authorized official title is Dentist/owner and has the following contact phone number (805) 544-7804.

The enumeration date for this NPI number is 4/13/2007 and was last updated on 8/4/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223G0001XDentistGeneral Practice62898CALIFORNIANo
21223G0001XDentistGeneral Practice58800CALIFORNIAYes

What is NPI?

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This page was last updated on: 3/30/2025

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