Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 2901020267 | MI |
N | 213EG0000X | General Practice | 2901020267 | MI |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 60829600 | WA |
NPI | 1316252836 |
---|---|
Provider Name | Dr. Vincent Joseph Slovan |
First Address | South Lyon, MI 48178-8812 |
Second Address | Jacksonville, FL 32212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2010 |
Last Update Date | 15/05/2018 |