Active NPI
Slade Wallace Lail, D.D.S.
- General Practice Dentistry
- Duluth, GA
National Provider Identifier
1902997109
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 11701
- Practice address
- 3415 Duluth Highway 120
Duluth, GA 30096-3354 - Phone
- (770) 476-2400
- Fax
- (770) 476-2394
- NPI assigned
- Sep 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 11701 | GA | Primary |
Addresses
Primary practice location
3415 Duluth Highway 120
Duluth, GA 30096-3354
Mailing address
3415 Duluth Highway 120
Duluth, GA 30096-3354
Phone (770) 476-2400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1902997109",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3415 DULUTH HIGHWAY 120",
"city": "DULUTH",
"state": "GA",
"postal_code": "300963354",
"telephone_number": "770-476-2400",
"fax_number": "770-476-2394"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3415 DULUTH HIGHWAY 120",
"city": "DULUTH",
"state": "GA",
"postal_code": "300963354",
"telephone_number": "770-476-2400",
"fax_number": "770-476-2394"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAIL",
"first_name": "SLADE",
"middle_name": "WALLACE",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "11701",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Duluth, GA
Sources for this page
- 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.