MEDICARE: DR. BOBBIE K 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	122300000X	Dentist	5101	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	73-1435469	OTHER		TAX ID

General Provider Information

NPI Number	:	1811991375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BOBBIE K BARTLETT DDS

Provider Business Mailing Address
First Line	:	28243 S LOVERS LN
Second Line	:
City	:	PARK HILL
State	:	OK
Zip	:	74451-2939
Country	:	US
Telephone Number	:	405-641-4544
Fax Number	:

Provider Business Practice Location Address
First Line	:	6521 S WESTERN AVE
Second Line	:	STE A
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-1705
Country	:	US
Telephone Number	:	405-634-2313
Fax Number	:	405-634-0474

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

Provider Enumeration Date	:	06/11/2005
Last Update Date	:	08/10/2014

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