Provider Demographics
NPI:1376624015
Name:BARTOW, WILLIAM BRIAN (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BRIAN
Last Name:BARTOW
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 257
Mailing Address - Street 2:547 WEST JACKSON ST
Mailing Address - City:MARSHFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65706
Mailing Address - Country:US
Mailing Address - Phone:417-859-2279
Mailing Address - Fax:417-859-2279
Practice Address - Street 1:547 WEST JACKSON ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MO
Practice Address - Zip Code:65706
Practice Address - Country:US
Practice Address - Phone:417-859-2279
Practice Address - Fax:417-859-2279
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO137971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice