Healthcare Provider Details

I. General information

NPI: 1003433814
Provider Name (Legal Business Name): SLADJANA BJELAC DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 SISKEY PKWY STE 100
MATTHEWS NC
28105-3224
US

IV. Provider business mailing address

5734 FAULCONBRIDGE RD
CHARLOTTE NC
28227-2521
US

V. Phone/Fax

Practice location:
  • Phone: 704-708-4402
  • Fax:
Mailing address:
  • Phone: 704-307-9455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11904
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: