Provider Demographics
NPI:1437321148
Name:LAWRENCE A. SLADEK, DDS
Entity Type:Organization
Organization Name:LAWRENCE A. SLADEK, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:SLADEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-545-3243
Mailing Address - Street 1:PO BOX 23308
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-0276
Mailing Address - Country:US
Mailing Address - Phone:704-545-3243
Mailing Address - Fax:704-545-9233
Practice Address - Street 1:7332 MATTHEWS MINT HILL RD.
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227
Practice Address - Country:US
Practice Address - Phone:704-545-3243
Practice Address - Fax:704-545-9233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC41161223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
97838OtherBLUE CROSS BLUE SHIELD
NC8997838Medicaid