Provider Demographics
NPI:1689179228
Name:SLEZAK, NICOLE NATALIE (DDS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:NATALIE
Last Name:SLEZAK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 US HIGHWAY 1 STE 103
Mailing Address - Street 2:
Mailing Address - City:AVENEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07001-1539
Mailing Address - Country:US
Mailing Address - Phone:732-582-4224
Mailing Address - Fax:
Practice Address - Street 1:1040 US HIGHWAY 1 STE 103
Practice Address - Street 2:
Practice Address - City:AVENEL
Practice Address - State:NJ
Practice Address - Zip Code:07001-1539
Practice Address - Country:US
Practice Address - Phone:732-582-4224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019032067122300000X
NJ22DI029288001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist