Healthcare Provider Details

I. General information

NPI: 1164577466
Provider Name (Legal Business Name): LEONARD JOSEPH BARTOSZEWICZ D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 BURTON ST SE
GRAND RAPIDS MI
49506-4600
US

IV. Provider business mailing address

2003 BURTON ST SE
GRAND RAPIDS MI
49506-4600
US

V. Phone/Fax

Practice location:
  • Phone: 616-245-9830
  • Fax: 616-245-5026
Mailing address:
  • Phone: 616-245-9830
  • Fax: 616-245-5026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901017430
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: