Healthcare Provider Details

I. General information

NPI: 1437321148
Provider Name (Legal Business Name): LAWRENCE A. SLADEK, DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7332 MATTHEWS MINT HILL RD.
CHARLOTTE NC
28227
US

IV. Provider business mailing address

PO BOX 23308
CHARLOTTE NC
28227-0276
US

V. Phone/Fax

Practice location:
  • Phone: 704-545-3243
  • Fax: 704-545-9233
Mailing address:
  • Phone: 704-545-3243
  • Fax: 704-545-9233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number4116
License Number StateNC

VIII. Authorized Official

Name: DR. LAWRENCE ALEXANDER SLADEK
Title or Position: OWNER
Credential: D.D.S.
Phone: 704-545-3243