Healthcare Provider Details

I. General information

NPI: 1124965249
Provider Name (Legal Business Name): HANOVER DENTAL CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16625 MOUNTAIN RD
MONTPELIER VA
23192-2660
US

IV. Provider business mailing address

16625 MOUNTAIN RD
MONTPELIER VA
23192-2660
US

V. Phone/Fax

Practice location:
  • Phone: 804-544-2499
  • Fax:
Mailing address:
  • Phone: 804-544-2499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TRACY JOHNSON
Title or Position: PRACTICE MANAGER
Credential:
Phone: 540-522-9347