Provider Demographics
NPI:1912067687
Name:BARTOLETTI, ROBERT THOMAS (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:THOMAS
Last Name:BARTOLETTI
Suffix:
Gender:M
Credentials:DMD
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 581
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:MT
Mailing Address - Zip Code:59749-0581
Mailing Address - Country:US
Mailing Address - Phone:406-842-5400
Mailing Address - Fax:406-842-5400
Practice Address - Street 1:115 MILL
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:MT
Practice Address - Zip Code:59749
Practice Address - Country:US
Practice Address - Phone:406-842-5400
Practice Address - Fax:406-842-5400
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT17091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT5510271Medicaid
MT0114933Medicaid