Provider Demographics
NPI:1780354415
Name:SLEZAK, JANIS ANN (RDH)
Entity type:Individual
Prefix:
First Name:JANIS
Middle Name:ANN
Last Name:SLEZAK
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12140 BRECKINRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-6033
Mailing Address - Country:US
Mailing Address - Phone:571-319-7621
Mailing Address - Fax:
Practice Address - Street 1:12140 BRECKINRIDGE LN
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-6033
Practice Address - Country:US
Practice Address - Phone:571-319-7621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402206910124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist