Provider Demographics
NPI:1962552695
Name:BARTELS, MICA A (DMD)
Entity type:Individual
Prefix:
First Name:MICA
Middle Name:A
Last Name:BARTELS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 N. MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONROE FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44262
Mailing Address - Country:US
Mailing Address - Phone:330-688-4942
Mailing Address - Fax:330-688-9064
Practice Address - Street 1:425 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MONROE FALLS
Practice Address - State:OH
Practice Address - Zip Code:44262
Practice Address - Country:US
Practice Address - Phone:330-688-4942
Practice Address - Fax:330-688-9064
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30021057122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist