Provider Demographics
NPI:1598829392
Name:BARTLETT, KENT D (DDSPA)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:D
Last Name:BARTLETT
Suffix:
Gender:M
Credentials:DDSPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S TULSA AVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-4600
Mailing Address - Country:US
Mailing Address - Phone:479-968-2100
Mailing Address - Fax:479-968-2197
Practice Address - Street 1:150 S TULSA AVE
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-4600
Practice Address - Country:US
Practice Address - Phone:479-968-2100
Practice Address - Fax:479-968-2107
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR 22981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice