Bryce E Slack

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D010940 Issued in AZ

Practice address

5400 W Northern Ave Ste 202
Glendale, AZ 85301-1591

Phone

(623) 500-5793

Fax

(623) 321-1030

NPI assigned

Jun 29, 2017

Reactivated

May 10, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Compass Point Dental PLLC

  • Dentist
  • Glendale, AZ
  • NPI 1467156406
  NPD Authorized official
• Spring Dental Pryor

  • General Practice Dentistry
  • Pryor, OK
  • NPI 1801333067
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1498694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740009600000",
    "number": "1013438100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9169 W ALEX AVE",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853828344",
            "telephone_number": "435-773-7175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5400 W NORTHERN AVE STE 202",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853011591",
            "telephone_number": "623-500-5793",
            "fax_number": "623-321-1030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SLACK",
        "first_name": "BRYCE",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-06-29",
        "last_updated": "2025-02-20",
        "certification_date": "2025-02-20",
        "deactivation_date": "2023-04-17",
        "reactivation_date": "2023-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "6979",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D010940",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• SK Dental LLC
• Ska-Shifra Facility
• Michaela M Skelly, M.D.
• Kristina Alba Skinner, D.O.
• Skylark Ach LLC
• Eric L Slater, R.PH.
• Pamela Michelle Slaughter, PHARMD
• Meghan Slavin, PT
• Erin Morgan Slawter
• David John Slebodnik, D.C.

• General Practice Dentistry in Glendale, AZ
• Providers in Glendale, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.