Provider Demographics
NPI:1114448826
Name:BARTELUS, GIBSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:GIBSON
Middle Name:
Last Name:BARTELUS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 POND LN
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-3132
Mailing Address - Country:US
Mailing Address - Phone:617-633-4312
Mailing Address - Fax:
Practice Address - Street 1:270 NEW STATE HWY STE 9A
Practice Address - Street 2:
Practice Address - City:RAYNHAM
Practice Address - State:MA
Practice Address - Zip Code:02767-5459
Practice Address - Country:US
Practice Address - Phone:508-822-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858161122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist