Healthcare Provider Details

I. General information

NPI: 1992796601
Provider Name (Legal Business Name): DANA E. SLESS, DO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 04/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3069 ENGLISH CREEK AVE STE 302
EGG HARBOR TOWNSHIP NJ
08234-9708
US

IV. Provider business mailing address

3069 ENGLISH CREEK AVE STE 302
EGG HARBOR TOWNSHIP NJ
08234-9708
US

V. Phone/Fax

Practice location:
  • Phone: 609-383-3800
  • Fax: 609-383-3839
Mailing address:
  • Phone: 609-383-3800
  • Fax: 609-383-3839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number25MB07099600
License Number StateNJ

VIII. Authorized Official

Name: MRS. DANA E SLESS
Title or Position: OWNER
Credential: DO
Phone: 609-383-3800