Provider Demographics
NPI:1740379015
Name:FREDERIC B SLETE D.D.S.,PC
Entity Type:Organization
Organization Name:FREDERIC B SLETE D.D.S.,PC
Other - Org Name:SLETE AND BRINK D.D.S.,PC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERIC
Authorized Official - Middle Name:B
Authorized Official - Last Name:SLETE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-787-5055
Mailing Address - Street 1:306 W WASHINGTON AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2169
Mailing Address - Country:US
Mailing Address - Phone:517-787-5055
Mailing Address - Fax:517-787-9346
Practice Address - Street 1:306 W WASHINGTON AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2169
Practice Address - Country:US
Practice Address - Phone:517-787-5055
Practice Address - Fax:517-787-9346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty