Provider Demographics
NPI:1992796601
Name:DANA E. SLESS, DO, LLC
Entity type:Organization
Organization Name:DANA E. SLESS, DO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SLESS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-383-3800
Mailing Address - Street 1:3069 ENGLISH CREEK AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-9708
Mailing Address - Country:US
Mailing Address - Phone:609-383-3800
Mailing Address - Fax:609-383-3839
Practice Address - Street 1:3069 ENGLISH CREEK AVE STE 302
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-9708
Practice Address - Country:US
Practice Address - Phone:609-383-3800
Practice Address - Fax:609-383-3839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07099600261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9091301Medicaid