Healthcare Provider Details

I. General information

NPI: 1194315135
Provider Name (Legal Business Name): DR. PALOMA ANTONIA BRISTOL BARTLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2021
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

991 W HUDSON BLVD
GASTONIA NC
28052-6430
US

IV. Provider business mailing address

991 W HUDSON BLVD
GASTONIA NC
28052-6430
US

V. Phone/Fax

Practice location:
  • Phone: 704-853-5191
  • Fax: 704-853-5131
Mailing address:
  • Phone: 704-853-5191
  • Fax: 704-853-5131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13659
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: