Provider Demographics
NPI:1154434710
Name:BARTLETT, JENNIFER HUBBARD (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:HUBBARD
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W BOWER AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-3524
Mailing Address - Country:US
Mailing Address - Phone:870-741-7117
Mailing Address - Fax:870-741-2298
Practice Address - Street 1:315 W BOWER AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-3524
Practice Address - Country:US
Practice Address - Phone:870-741-7117
Practice Address - Fax:870-741-2298
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3308122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U454OtherBCBS
AR697386OtherUNITED CONCORDIA
AR138320608Medicaid
AR5U454OtherBCBS