MEDICARE: DR. KATHLEEN BARTUNEK DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D1365	SD

General Provider Information

NPI Number	:	1689303620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN BARTUNEK DDS

Provider Business Mailing Address
First Line	:	6420 S BEAL AVE APT 5
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-4142
Country	:	US
Telephone Number	:	402-469-4873
Fax Number	:

Provider Business Practice Location Address
First Line	:	4603 W HOMEFIELD DR
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-3511
Country	:	US
Telephone Number	:	605-275-2424
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2022
Last Update Date	:	06/06/2022

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