Healthcare Provider Details

I. General information

NPI: 1609809250
Provider Name (Legal Business Name): RICHARD PETER BARTLING D.D.S., F.R.C.D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 06/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3011 ABIGAIL LN
MIDLAND MI
48640
US

IV. Provider business mailing address

3011 ABIGAIL LN
MIDLAND MI
48640-6937
US

V. Phone/Fax

Practice location:
  • Phone: 989-123-4567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberRB017584
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: