1437321148 NPI number — LAWRENCE A. SLADEK, DDS

Table of content: DR. GARY KIN TET PANG M.D. (NPI 1851486310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437321148 NPI number — LAWRENCE A. SLADEK, DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAWRENCE A. SLADEK, DDS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437321148
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 23308
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28227-0276
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-545-3243
Provider Business Mailing Address Fax Number:
704-545-9233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7332 MATTHEWS MINT HILL RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-545-3243
Provider Business Practice Location Address Fax Number:
704-545-9233
Provider Enumeration Date:
04/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SLADEK
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
ALEXANDER
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
704-545-3243

Provider Taxonomy Codes

  • Taxonomy code: 1223D0001X , with the licence number:  4116 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 97838 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8997838 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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