Healthcare Provider Details

I. General information

NPI: 1326770462
Provider Name (Legal Business Name): SLADJANA BJELAC DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 COLTSGOUTE ROAD SUITE 104
CHARLOTTE NC
28211
US

IV. Provider business mailing address

2701 COLTSGOUTE ROAD SUITE 104
CHARLOTTE NC
28211
US

V. Phone/Fax

Practice location:
  • Phone: 980-224-2336
  • Fax: 980-224-2336
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SLADJANA BJELAC
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 704-701-7104