Provider Demographics
NPI:1336672369
Name:BARTULIS, DAIVA (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAIVA
Middle Name:
Last Name:BARTULIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4159 PUNTA ALTA DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-1144
Mailing Address - Country:US
Mailing Address - Phone:310-940-5174
Mailing Address - Fax:310-659-1302
Practice Address - Street 1:8500 WILSHIRE BLVD.
Practice Address - Street 2:SUITE1004
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3102
Practice Address - Country:US
Practice Address - Phone:310-659-1510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47449122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist