Healthcare Provider Details

I. General information

NPI: 1366651309
Provider Name (Legal Business Name): DEAN M BARTLETT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 AVIATION RD BLDG A
QUEENSBURY NY
12804-2915
US

IV. Provider business mailing address

333 AVIATION RD BLDG A
QUEENSBURY NY
12804-2915
US

V. Phone/Fax

Practice location:
  • Phone: 518-793-8511
  • Fax: 518-793-8588
Mailing address:
  • Phone: 518-793-8511
  • Fax: 518-793-8588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number031432-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: