Provider Demographics
NPI:1225893936
Name:BARTLETT TOLLEFSON DENTAL LLC
Entity Type:Organization
Organization Name:BARTLETT TOLLEFSON DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLLEFSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-210-9243
Mailing Address - Street 1:3627 GOLDRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-5637
Mailing Address - Country:US
Mailing Address - Phone:715-210-9243
Mailing Address - Fax:
Practice Address - Street 1:3838 TALMADGE RD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-1103
Practice Address - Country:US
Practice Address - Phone:715-210-9243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental