Provider Demographics
NPI:1760686091
Name:BARTLETT, MICHAEL SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SCOTT
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 1:3140 CENTRAL MALL DRIVE
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-8039
Mailing Address - Country:US
Mailing Address - Phone:409-727-2164
Mailing Address - Fax:409-727-5222
Practice Address - Street 1:3140 CENTRAL MALL DR.
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8039
Practice Address - Country:US
Practice Address - Phone:409-727-2164
Practice Address - Fax:409-727-5222
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice