Provider Demographics
NPI:1437342151
Name:PLOSZAK, STEFAN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEFAN
Middle Name:A
Last Name:PLOSZAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 SOUTH BLVD
Mailing Address - Street 2:STE F
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-4458
Mailing Address - Country:US
Mailing Address - Phone:704-247-0400
Mailing Address - Fax:704-556-5950
Practice Address - Street 1:6801 SOUTH BLVD
Practice Address - Street 2:STE F
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-4458
Practice Address - Country:US
Practice Address - Phone:704-247-0400
Practice Address - Fax:704-556-5950
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC83951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907948Medicaid