Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 11904 | NC |
NPI | 1003433814 |
---|---|
Provider Name | Dr. Sladjana Bjelac |
First Address | Charlotte, NC 28227-2521 |
Second Address | Matthews, NC 28105-3224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2020 |
Last Update Date | 26/06/2020 |