Provider Demographics
NPI:1558984013
Name:DANJELA BRATIC TART DDS JARED A HOOVER DDS & M SCOTT GORE DDS PC
Entity Type:Organization
Organization Name:DANJELA BRATIC TART DDS JARED A HOOVER DDS & M SCOTT GORE DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIJELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-703-8167
Mailing Address - Street 1:4714 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1224
Mailing Address - Country:US
Mailing Address - Phone:602-703-8167
Mailing Address - Fax:
Practice Address - Street 1:9015 FOREST HILL AVE STE C
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-3050
Practice Address - Country:US
Practice Address - Phone:602-703-8167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL VIRGINIA DENTAL CARE PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty