Provider Demographics
NPI:1225001134
Name:HRSTIC, IVANA K (DDS)
Entity Type:Individual
Prefix:DR
First Name:IVANA
Middle Name:K
Last Name:HRSTIC
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 1:1800 WEST END AVENUE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1405
Mailing Address - Country:US
Mailing Address - Phone:615-327-4904
Mailing Address - Fax:615-320-5836
Practice Address - Street 1:1800 WEST END AVENUE
Practice Address - Street 2:SUITE 102
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1405
Practice Address - Country:US
Practice Address - Phone:615-327-4904
Practice Address - Fax:615-320-5836
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN81461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN9177384Medicaid