Provider Demographics
NPI:1265434377
Name:WARTELL, ROBERT L (D M D)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:WARTELL
Suffix:
Gender:M
Credentials:D M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 GALISTEO ST
Mailing Address - Street 2:STE J2
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-2103
Mailing Address - Country:US
Mailing Address - Phone:505-474-4644
Mailing Address - Fax:877-748-9620
Practice Address - Street 1:2019 GALISTEO ST
Practice Address - Street 2:STE J2
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2103
Practice Address - Country:US
Practice Address - Phone:505-474-4644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD1971122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist