Provider Demographics
NPI:1174738900
Name:BARTLEY, TERESA (DMD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:
Last Name:BARTLEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5006 COLLINS HWY
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-6842
Mailing Address - Country:US
Mailing Address - Phone:606-639-4441
Mailing Address - Fax:606-639-9785
Practice Address - Street 1:5006 COLLINS HWY
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-6842
Practice Address - Country:US
Practice Address - Phone:606-639-4441
Practice Address - Fax:606-639-9785
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY51551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice