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General NPI Number Information
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NPI Number | 1568983526
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Entity Type | Individual
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Provider Name | DANIJELA BRATIC TART DMD
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Gender | Female
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Dates
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Enumeration Date | 06/29/2017
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Last Update Date | 05/30/2020
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Provider Practice Location Address
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Address Line | 9015 FOREST HILL AVE
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-3050
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Country | US
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Telephone | 804-272-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 4714 PARK AVE
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City | RICHMOND
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State | VA
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Zip | 23226-1224
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Country | US
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Telephone | 602-703-8167
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401415742
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License Number State | VA
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