Provider Demographics
NPI:1417001413
Name:BARTLETT, BRUCE KIRBY (DDS)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:KIRBY
Last Name:BARTLETT
Suffix:
Gender:M
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:PO BOX 318
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:NV
Mailing Address - Zip Code:89444
Mailing Address - Country:US
Mailing Address - Phone:775-291-6255
Mailing Address - Fax:
Practice Address - Street 1:14567 BIG BASIN WAY
Practice Address - Street 2:SUITE B2
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-6039
Practice Address - Country:US
Practice Address - Phone:408-868-6336
Practice Address - Fax:408-868-0116
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30904122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist