Provider Demographics
NPI:1003433814
Name:BJELAC, SLADJANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SLADJANA
Middle Name:
Last Name:BJELAC
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 1:5734 FAULCONBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-2521
Mailing Address - Country:US
Mailing Address - Phone:704-307-9455
Mailing Address - Fax:
Practice Address - Street 1:3320 SISKEY PKWY STE 100
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-3224
Practice Address - Country:US
Practice Address - Phone:704-708-4402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11904122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist