Provider Demographics
NPI:1629082441
Name:BARDWELL, DAVID N (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:N
Last Name:BARDWELL
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 TURNPIKE ST
Mailing Address - Street 2:UNIT 63A
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5922
Mailing Address - Country:US
Mailing Address - Phone:978-683-8855
Mailing Address - Fax:978-738-9687
Practice Address - Street 1:565 TURNPIKE ST
Practice Address - Street 2:UNIT 63A
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5922
Practice Address - Country:US
Practice Address - Phone:978-683-8855
Practice Address - Fax:978-738-9687
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA161941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice