Provider Demographics
NPI:1275676025
Name:GOSTOVICH, TARA LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:LYNN
Last Name:GOSTOVICH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 COUNTY ROAD 520
Mailing Address - Street 2:SUITE D
Mailing Address - City:ENGLISHTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8297
Mailing Address - Country:US
Mailing Address - Phone:732-617-1211
Mailing Address - Fax:732-617-1144
Practice Address - Street 1:14 COUNTY ROAD 520
Practice Address - Street 2:SUITE D
Practice Address - City:ENGLISHTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8297
Practice Address - Country:US
Practice Address - Phone:732-617-1211
Practice Address - Fax:732-617-1144
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI021842001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics