MEDICARE: DR. MICHAEL SCOTT BARTLETT 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	1223G0001X	General Practice Dentistry	21746	TX

General Provider Information

NPI Number	:	1760686091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL SCOTT BARTLETT DDS

Provider Business Mailing Address
First Line	:	3140 CENTRAL MALL DRIVE
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-8039
Country	:	US
Telephone Number	:	409-727-2164
Fax Number	:	409-727-5222

Provider Business Practice Location Address
First Line	:	3140 CENTRAL MALL DR.
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-8039
Country	:	US
Telephone Number	:	409-727-2164
Fax Number	:	409-727-5222

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

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	01/26/2012

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