Provider Demographics
NPI:1053912121
Name:DANVILLE DOWNTOWN DENTISTRY LLC
Entity type:Organization
Organization Name:DANVILLE DOWNTOWN DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-679-8506
Mailing Address - Street 1:6443 W 10TH ST STE 204
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-6502
Mailing Address - Country:US
Mailing Address - Phone:317-247-9512
Mailing Address - Fax:
Practice Address - Street 1:94 S TENNESSEE ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-1836
Practice Address - Country:US
Practice Address - Phone:317-745-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty