Provider Demographics
NPI:1851695746
Name:BARTLE, THOMAS RICHARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:RICHARD
Last Name:BARTLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22554 VENTURA BLVD
Mailing Address - Street 2:#117
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1413
Mailing Address - Country:US
Mailing Address - Phone:818-224-2095
Mailing Address - Fax:818-224-2096
Practice Address - Street 1:22554 VENTURA BLVD
Practice Address - Street 2:#117
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1413
Practice Address - Country:US
Practice Address - Phone:818-224-2095
Practice Address - Fax:818-224-2096
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38034122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist