Provider Demographics
NPI:1912194275
Name:BARTZ, RAYMOND DENIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:DENIS
Last Name:BARTZ
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 1:8704 S RIDGELAND AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-1068
Mailing Address - Country:US
Mailing Address - Phone:708-430-4440
Mailing Address - Fax:708-430-4528
Practice Address - Street 1:8704 S RIDGELAND AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-1068
Practice Address - Country:US
Practice Address - Phone:708-430-4440
Practice Address - Fax:708-430-4528
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19014517122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist