Provider Demographics
NPI:1023105582
Name:DAVID J SLEZAK DDS PC
Entity type:Organization
Organization Name:DAVID J SLEZAK DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:SLEZAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-653-2212
Mailing Address - Street 1:110 E THIRD ST
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423
Mailing Address - Country:US
Mailing Address - Phone:810-653-2212
Mailing Address - Fax:810-658-4330
Practice Address - Street 1:110 E THIRD ST
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423
Practice Address - Country:US
Practice Address - Phone:810-653-2212
Practice Address - Fax:810-658-4330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI15359122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2953450Medicaid