Provider Demographics
NPI:1184022626
Name:HARTMAN, VANESSA ZULEMA (DDS)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:ZULEMA
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11713 JEFFERSON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2400
Mailing Address - Country:US
Mailing Address - Phone:757-873-3407
Mailing Address - Fax:757-873-2565
Practice Address - Street 1:11713 JEFFERSON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2400
Practice Address - Country:US
Practice Address - Phone:757-873-3407
Practice Address - Fax:757-873-2565
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414686122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist