Thomas A Slack, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

2901013823 Issued in MI

Practice address

3801 Glenkerry CT
Portage, MI 49024-0718

Phone

(269) 323-1527

Fax

(269) 323-1670

NPI assigned

Mar 29, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1669433793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 GLENKERRY CT",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490240718",
            "telephone_number": "269-323-1527",
            "fax_number": "269-323-1670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 GLENKERRY CT",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490240718",
            "telephone_number": "269-323-1527",
            "fax_number": "269-323-1670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SLACK",
        "first_name": "THOMAS",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-29",
        "last_updated": "2025-09-11",
        "certification_date": "2020-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MI",
            "license": "2901013823",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2675451",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2990919",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laurie Sindelar
• Lashala Sivley
• Jaroslaw P Siwik, MD
• Sophie Skochelak, LLMSW
• Lindsey Alexandra Skolnik, DO
• Ronald D Slager
• Brianna Slaten
• Sleep Health
• Mark Alan Sloane, D.O.
• Jenna Slot, WHNP-BC

• Oral and Maxillofacial Surgery (Dentist) in Portage, MI
• Providers in Portage, MI by specialty
• Oral and Maxillofacial Surgery (Dentist) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 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.