Provider Demographics
NPI:1306819933
Name:BARTLETT, RICHARD SOMMERVILLE JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SOMMERVILLE
Last Name:BARTLETT
Suffix:JR
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 1:8366 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-3843
Mailing Address - Country:US
Mailing Address - Phone:619-463-9301
Mailing Address - Fax:619-463-3516
Practice Address - Street 1:8366 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-3843
Practice Address - Country:US
Practice Address - Phone:619-463-9301
Practice Address - Fax:619-463-3516
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA310111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice