Provider Demographics
NPI:1821447350
Name:BARTLETT, SAMUEL MCKENZIE YOUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:MCKENZIE YOUNG
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 1:3712 LAWNDALE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-3065
Mailing Address - Country:US
Mailing Address - Phone:336-419-1099
Mailing Address - Fax:336-419-1104
Practice Address - Street 1:3712 LAWNDALE DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-3065
Practice Address - Country:US
Practice Address - Phone:336-419-1099
Practice Address - Fax:336-419-1104
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice