Molly Slack, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D7600 Issued in OR

Practice address

1200 W Oak St
Lebanon, OR 97355-1254

Phone

(541) 258-7884

Fax

(541) 258-7834

NPI assigned

Aug 12, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053323618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 W OAK ST",
            "city": "LEBANON",
            "state": "OR",
            "postal_code": "973551254",
            "telephone_number": "541-258-7884",
            "fax_number": "541-258-7834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W OAK ST",
            "city": "LEBANON",
            "state": "OR",
            "postal_code": "973551254",
            "telephone_number": "541-258-7884",
            "fax_number": "541-258-7834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SLACK",
        "first_name": "MOLLY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D7600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lucas Cole Short
• Terry Wayne Shortridge, MD
• Connor Alexander Shortt
• David Paul Shrader, PT
• Raymond Anthony Simon II, MD
• Anna Elizabeth Slade, PT, DPT
• Shelia Faye Sloan
• Amanda Nicole Smith, LPN
• Angela M Smith, RD, LD, CDM
• Esebia L Smith

• Dentist in Lebanon, OR
• Providers in Lebanon, OR by specialty
• Dentist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.