Healthcare Provider Details

I. General information

NPI: 1184552572
Provider Name (Legal Business Name): RENE EMIL BOLJKOVAC DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5139 W SAGINAW HWY
LANSING MI
48917-2635
US

IV. Provider business mailing address

1244 CRAVEN DR
HIGHLAND MI
48356-1131
US

V. Phone/Fax

Practice location:
  • Phone: 517-318-2657
  • Fax: 517-323-7140
Mailing address:
  • Phone: 289-251-6439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901015588
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: