Provider Demographics
NPI:1477604411
Name:BARTRUFF, MICHAEL SCOTT (DMD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:SCOTT
Last Name:BARTRUFF
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 RIVERSIDE PKWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-5939
Mailing Address - Country:US
Mailing Address - Phone:770-822-3400
Mailing Address - Fax:
Practice Address - Street 1:2003 RIVERSIDE PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5939
Practice Address - Country:US
Practice Address - Phone:770-822-3400
Practice Address - Fax:770-995-5772
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0123891223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics