Provider Demographics
NPI:1700623766
Name:BARTLEY, ALLISON (DMD)
Entity type:Individual
Prefix:
First Name:ALLISON
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 1:1123 ORANGERY CT
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-1397
Mailing Address - Country:US
Mailing Address - Phone:630-596-3278
Mailing Address - Fax:
Practice Address - Street 1:76 STRATFORD DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2201
Practice Address - Country:US
Practice Address - Phone:630-894-5180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019035064122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty