MEDICARE: DR. RAYMOND DENIS BARTZ 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	19014517	IL

General Provider Information

NPI Number	:	1912194275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND DENIS BARTZ DDS

Provider Business Mailing Address
First Line	:	8704 S RIDGELAND AVE
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-1068
Country	:	US
Telephone Number	:	708-430-4440
Fax Number	:	708-430-4528

Provider Business Practice Location Address
First Line	:	8704 S RIDGELAND AVE
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-1068
Country	:	US
Telephone Number	:	708-430-4440
Fax Number	:	708-430-4528

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

Provider Enumeration Date	:	10/01/2007
Last Update Date	:	10/01/2007

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