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General NPI Number Information
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NPI Number | 1659666808
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Entity Type | Organization
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Legal Business Name | SLENTZ SURGICAL LLC
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Dates
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Enumeration Date | 06/16/2011
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Last Update Date | 06/16/2011
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Provider Practice Location Address
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Address Line | 319 W CALL ST BLDG B STE A
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City | STARKE
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State | FL
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Zip | 32091-3113
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Country | US
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Telephone | 908-368-8100
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Fax | 908-368-8120
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Provider Business Mailing Address
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Address Line | 319 W CALL ST BLDG B STE A
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City | STARKE
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State | FL
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Zip | 32091-3113
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Country | US
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Telephone | 908-368-8100
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Fax | 908-368-8120
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEVIN D SLENTZ
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Credential | MD
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Telephone | 908-368-8100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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