Provider Demographics
NPI:1962520684
Name:BARTOLOME, ERICK A (DDS)
Entity type:Individual
Prefix:DR
First Name:ERICK
Middle Name:A
Last Name:BARTOLOME
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 1:6020 SEA BLUFF DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PLAYA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:90094-2252
Mailing Address - Country:US
Mailing Address - Phone:310-496-6000
Mailing Address - Fax:310-496-6004
Practice Address - Street 1:6020 SEA BLUFF DR
Practice Address - Street 2:SUITE 5
Practice Address - City:PLAYA VISTA
Practice Address - State:CA
Practice Address - Zip Code:90094-2252
Practice Address - Country:US
Practice Address - Phone:310-496-6000
Practice Address - Fax:310-496-6004
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA542351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice