Provider Demographics
NPI:1952425282
Name:BARTLETT PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:BARTLETT PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDI
Authorized Official - Middle Name:
Authorized Official - Last Name:STUHR
Authorized Official - Suffix:
Authorized Official - Credentials:CDA, RDA
Authorized Official - Phone:901-382-1564
Mailing Address - Street 1:3071 KIRBY WHITTEN RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-2822
Mailing Address - Country:US
Mailing Address - Phone:901-382-1564
Mailing Address - Fax:901-382-0657
Practice Address - Street 1:3071 KIRBY WHITTEN RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2822
Practice Address - Country:US
Practice Address - Phone:901-382-1564
Practice Address - Fax:901-382-0657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS27221223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0100184OtherBLUE CROSS BLUE SHIELD