Individual provider Active NPI

Paul D Bartlam, DDS

  • General Practice Dentistry
  • Cloquet, MN
National Provider Identifier
1720167943
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
11066 Issued in MN
Practice address
716 14TH St
Cloquet, MN 55720-2406
Phone
(218) 879-5271
NPI assigned
Nov 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 11066 MN Primary

Addresses

Primary practice location

716 14TH St
Cloquet, MN 55720-2406

Mailing address

716 14TH St
Cloquet, MN 55720-2406
Phone (218) 879-5271

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210520001807 MN Practitioner - Dentist 0941500086 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Superior Dental Associates General Practice CurrentSince Feb 11, 2021 Accepting new patients
Sla Dental PLLC General Practice PastSince Feb 11, 2021 Accepting new patients
North Country Dental General Practice PastSince Aug 30, 2020 Accepting new patients

Locations

716 14th St
Cloquet, MN 55720
Phone (218) 879-5271

1225 E 1st St
Duluth, MN 55805
Phone (218) 623-7005

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720167943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "716 14TH ST",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "557202406",
            "telephone_number": "218-879-5271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "716 14TH ST",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "557202406",
            "telephone_number": "218-879-5271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARTLAM",
        "first_name": "PAUL",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "11066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cloquet, MN

Sources for this page

Verify at the official NPI Registry.