Healthcare Provider Details

I. General information

NPI: 1558794404
Provider Name (Legal Business Name): MARIA BARTOLETTI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 CENTENNIAL AVE
BUTTE MT
59701-2870
US

IV. Provider business mailing address

445 CENTENNIAL AVE
BUTTE MT
59701-2870
US

V. Phone/Fax

Practice location:
  • Phone: 406-490-9354
  • Fax:
Mailing address:
  • Phone: 406-490-9354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6005
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number6005
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: