Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 2901011007 | MI |
NPI | 1306826276 |
---|---|
Provider Name | Lance G. Bartz |
First Address | Fenwick, MI 48834-9537 |
Second Address | Stanton, MI 48888-9297 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4846066 | (05) | MI |