Provider Demographics
NPI:1437558608
Name:SLENDERLITE, LLC
Entity Type:Organization
Organization Name:SLENDERLITE, LLC
Other - Org Name:SKIN APPEAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-293-8242
Mailing Address - Street 1:4344 20TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-7436
Mailing Address - Country:US
Mailing Address - Phone:701-277-7200
Mailing Address - Fax:
Practice Address - Street 1:4344 20TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-7436
Practice Address - Country:US
Practice Address - Phone:701-277-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center