Provider Demographics
NPI:1720141831
Name:BARTOSH, STEVEN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:A
Last Name:BARTOSH
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 1:1445 WELLINGTON TERRRACE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321
Mailing Address - Country:US
Mailing Address - Phone:219-614-1611
Mailing Address - Fax:219-614-1611
Practice Address - Street 1:1445 WELLINGTON TER
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-4369
Practice Address - Country:US
Practice Address - Phone:219-614-1611
Practice Address - Fax:219-613-1611
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12006699A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12006699AOtherSTATE DENTIST LICENSE