Provider Demographics
NPI:1154328441
Name:BARTELS, VIRGIL ANTHONY WILLIAM III (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIRGIL ANTHONY
Middle Name:WILLIAM
Last Name:BARTELS
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:811 WINDOVER RD STE A
Mailing Address - Street 2:STE A
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-6094
Mailing Address - Country:US
Mailing Address - Phone:870-935-8000
Mailing Address - Fax:870-930-3977
Practice Address - Street 1:811 WINDOVER RD
Practice Address - Street 2:STE A
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6094
Practice Address - Country:US
Practice Address - Phone:870-935-8000
Practice Address - Fax:870-930-3977
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR31611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR162407608OtherARKANSAS MEDICAID
AR855177OtherUNITED CONCORDIA ID
AR5T143OtherARKANSAS BLUE CROSS BLUE SHIELD