Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DS043108 | PA |
NPI | 1003578626 |
---|---|
Provider Name | Dr. Samantha Slutsky |
First Address | Philadelphia, PA 19103-3026 |
Second Address | Philadelphia, PA 19124-1562 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2021 |
Last Update Date | 22/01/2022 |