Provider Demographics
NPI:1811589492
Name:BARTLETT, WHITNEY NICCOLE (BSDH, RDH, LAP)
Entity Type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:NICCOLE
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:BSDH, RDH, LAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2105
Mailing Address - Street 2:
Mailing Address - City:THOMPSON FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59873-2105
Mailing Address - Country:US
Mailing Address - Phone:541-910-9029
Mailing Address - Fax:
Practice Address - Street 1:533 MAPLE ST
Practice Address - Street 2:
Practice Address - City:THOMPSON FALLS
Practice Address - State:MT
Practice Address - Zip Code:59873
Practice Address - Country:US
Practice Address - Phone:541-910-9029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-RDH-LIC-4217124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist