Provider Demographics
NPI:1215247606
Name:MICHAEL S BARTLETT DDS PC
Entity type:Organization
Organization Name:MICHAEL S BARTLETT DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BARTLETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:409-727-2164
Mailing Address - Street 1:3185 MERRIMAN STREET
Mailing Address - Street 2:
Mailing Address - City:PORT NECHES
Mailing Address - State:TX
Mailing Address - Zip Code:77651
Mailing Address - Country:US
Mailing Address - Phone:409-727-2164
Mailing Address - Fax:409-727-5222
Practice Address - Street 1:3185 MERRIMAN STREET
Practice Address - Street 2:
Practice Address - City:PORT NECHES
Practice Address - State:TX
Practice Address - Zip Code:77651
Practice Address - Country:US
Practice Address - Phone:409-727-2164
Practice Address - Fax:409-727-5222
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHAEL S BARTLETT DDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21746122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty