Provider Demographics
NPI:1033598842
Name:BARTHOLOMEW, WHITLEY WAYNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:WHITLEY
Middle Name:WAYNE
Last Name:BARTHOLOMEW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:SNOW HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28580-0125
Mailing Address - Country:US
Mailing Address - Phone:252-747-8106
Mailing Address - Fax:252-747-8680
Practice Address - Street 1:105 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:SNOW HILL
Practice Address - State:NC
Practice Address - Zip Code:28580-1337
Practice Address - Country:US
Practice Address - Phone:252-747-8106
Practice Address - Fax:252-747-8680
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice