Provider Demographics
NPI:1932452638
Name:BJELAJAC, STANKO (DDS)
Entity Type:Individual
Prefix:DR
First Name:STANKO
Middle Name:
Last Name:BJELAJAC
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 1:9225 W CHARLESTON BLVD APT 1007
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-7050
Mailing Address - Country:US
Mailing Address - Phone:310-753-9966
Mailing Address - Fax:
Practice Address - Street 1:1795 EL CAMINO REAL STE 100
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1165
Practice Address - Country:US
Practice Address - Phone:310-753-9966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLL-307-12122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist