Healthcare Provider Details

I. General information

NPI: 1306826276
Provider Name (Legal Business Name): LANCE G. BARTZ D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W MAIN ST
STANTON MI
48888-9297
US

IV. Provider business mailing address

9055 COLLINS RD
FENWICK MI
48834-9537
US

V. Phone/Fax

Practice location:
  • Phone: 989-831-7071
  • Fax:
Mailing address:
  • Phone: 989-248-3660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number2901011007
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: