Provider Demographics
NPI:1326770462
Name:SLADJANA BJELAC DDS PLLC
Entity Type:Organization
Organization Name:SLADJANA BJELAC DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SLADJANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BJELAC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-701-7104
Mailing Address - Street 1:2701 COLTSGOUTE ROAD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2701 COLTSGOUTE ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211
Practice Address - Country:US
Practice Address - Phone:980-224-2336
Practice Address - Fax:980-224-2336
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SLADJANA BJELAC DDS PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty