Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 18437 | TX |
NPI | 1114004264 |
---|---|
Provider Name | Dr. Joseph Anthony Bartoloni |
First Address | Lackland A F B, TX 78236-9908 |
Second Address | Lackland A F B, TX 78236-9908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |