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Deactivated NPI 1013438100 Deactivated / Inactive NPI Male Practitioner

Bryce E Slack

Dentist - General Practice • Glendale, AZ

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Bryce Slack has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date June 29, 2017
NPI Deactivation Date April 17, 2023
Total Practice Duration ~6 Years of Practice (2017 – 2023)

Professional Overview & Biography Verified Profile Summary

Bryce Slack was a registered Dentist - General Practice practicing in Glendale, AZ. Throughout an active medical career spanning 6 years, Bryce Slack provided care at the practice location at 5400 W NORTHERN AVE STE 202 until profile deactivation on 2023-04-17.

Practice Location & Contact Primary Location

Practice Address

5400 W Northern Ave Ste 202

Glendale, AZ 853011591

Telephone 6235005793
Fax 6233211030
Associated Practice Facility / Clinic
🏢 Compass Point Dental Pllc Facility NPI 1467156406

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Glendale, AZ

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 18.5 Yrs
State Avg: 16.4 Yrs
Regional Practice Density
150 Specialists

Practicing in Glendale, AZ (2600 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2025-02-20
Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License AZ D010940

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Dentist - General Practice

NUCC Taxonomy Code: 1223G0001X

State License OK 6979

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
Dr. Edward Furlong , DMD

Dentist - General Practice

NPI 1558987271

Doctor of Dental Medicine

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

13 Historical Events
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Updated Practice Location February 20, 2025

Registered at 5400 W NORTHERN AVE STE 202, GLENDALE, AZ 853011591 (Tel: 6235005793)

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Updated Business Mailing Address February 20, 2025

Registered at 9169 W ALEX AVE, PEORIA, AZ 853828344 (Tel: 4357737175)

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Updated Practice Location May 10, 2023

Registered at 101 S ADAIR ST, PRYOR, OK 743613625 (Tel: 9188257111)

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Updated Business Mailing Address May 10, 2023

Registered at 2007 E 133RD ST S, BIXBY, OK 740081200 (Tel: 4357737175)

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Provider Name / Credentials Updated May 10, 2023

Recorded as BRYCE SLACK

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Medical Taxonomy / Specialty Registered (Primary Specialty) May 10, 2023

Dentist (License #6979 in OK)

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NPI Profile Deactivated April 17, 2023

Record deactivated on April 17, 2023

NPI Profile Active June 29, 2017

NPI status registered as active in NPPES database

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Updated Practice Location June 29, 2017

Registered at 101 S ADAIR ST, PRYOR, OK 743613625 (Tel: 9188257111)

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Updated Business Mailing Address June 29, 2017

Registered at 2007 E 133RD ST S, BIXBY, OK 740081200 (Tel: 4357737175)

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Provider Name / Credentials Updated June 29, 2017

Recorded as BRYCE SLACK

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Medical Taxonomy / Specialty Registered (Primary Specialty) June 29, 2017

Dentist (License #6979 in OK)

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Initial NPI Registration & Enumeration June 29, 2017

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1013438100
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: June 29, 2017
Last Update: February 20, 2025
Deactivation Date: April 17, 2023
Sole Proprietor: Yes

Mailing Address

9169 W Alex Ave

Peoria, AZ 853828344

Phone: 4357737175

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.