Healthcare Provider Details

I. General information

NPI: 1972542702
Provider Name (Legal Business Name): JAMES P BARTLETT SR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 W MAIN ST
ATLANTA TX
75551-3430
US

IV. Provider business mailing address

908 W MAIN ST
ATLANTA TX
75551-3430
US

V. Phone/Fax

Practice location:
  • Phone: 903-796-7183
  • Fax:
Mailing address:
  • Phone: 903-796-7183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number09760
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: