Provider Demographics
NPI:1427128370
Name:BARTLETT, DANIEL PHILLIP (DDS)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:PHILLIP
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 1:6011 DAGLE DR
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50311-2118
Mailing Address - Country:US
Mailing Address - Phone:515-277-0747
Mailing Address - Fax:
Practice Address - Street 1:1000 73RD ST STE 1
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50311
Practice Address - Country:US
Practice Address - Phone:515-223-5001
Practice Address - Fax:515-327-6282
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA74101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice