Provider Demographics
NPI:1619956869
Name:BARTLETT, KATHERINE P (DMD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:P
Last Name:BARTLETT
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 1:808 S BROADWAY ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-2305
Mailing Address - Country:US
Mailing Address - Phone:502-863-2106
Mailing Address - Fax:
Practice Address - Street 1:808 S BROADWAY ST
Practice Address - Street 2:STE. 9
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-2305
Practice Address - Country:US
Practice Address - Phone:502-863-2106
Practice Address - Fax:502-863-2180
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-14
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY62331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice