Provider Demographics
NPI:1366651309
Name:BARTLETT, DEAN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:M
Last Name:BARTLETT
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 1:333 AVIATION RD BLDG A
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-2915
Mailing Address - Country:US
Mailing Address - Phone:518-793-8511
Mailing Address - Fax:518-793-8588
Practice Address - Street 1:333 AVIATION RD BLDG A
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-2915
Practice Address - Country:US
Practice Address - Phone:518-793-8511
Practice Address - Fax:518-793-8588
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031432-11223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY141629796OtherTAX IDENTIFICATION NUMBER