Provider Demographics
NPI:1285797233
Name:BARTOLETTI, EDWARD ANTONE (DMD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ANTONE
Last Name:BARTOLETTI
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 1:215 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-2212
Mailing Address - Country:US
Mailing Address - Phone:406-563-5450
Mailing Address - Fax:
Practice Address - Street 1:215 HICKORY ST
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-2212
Practice Address - Country:US
Practice Address - Phone:406-563-5450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1410122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0111930Medicaid
MT1410-4OtherBLUE CROSS
MT5510713OtherCHIP