Provider Demographics
NPI:1770706327
Name:BARTKOWSKI, ROBERT DAVID (DDS)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DAVID
Last Name:BARTKOWSKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:D
Other - Last Name:BARTKOWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:155 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-3126
Mailing Address - Country:US
Mailing Address - Phone:860-646-1515
Mailing Address - Fax:
Practice Address - Street 1:155 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-3126
Practice Address - Country:US
Practice Address - Phone:860-646-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4075122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist