Provider Demographics
NPI:1164577466
Name:BARTOSZEWICZ, LEONARD JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:JOSEPH
Last Name:BARTOSZEWICZ
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 1:2003 BURTON ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-4600
Mailing Address - Country:US
Mailing Address - Phone:616-245-9830
Mailing Address - Fax:616-245-5026
Practice Address - Street 1:2003 BURTON ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-4600
Practice Address - Country:US
Practice Address - Phone:616-245-9830
Practice Address - Fax:616-245-5026
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010174301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice