Provider Demographics
NPI:1568813640
Name:C W BARTHOLOMEW, DDS, PC
Entity Type:Organization
Organization Name:C W BARTHOLOMEW, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:BARTHOLOMEW
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-453-0291
Mailing Address - Street 1:3415 S LAFOUNTAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-3802
Mailing Address - Country:US
Mailing Address - Phone:765-453-0291
Mailing Address - Fax:
Practice Address - Street 1:3415 S LAFOUNTAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3802
Practice Address - Country:US
Practice Address - Phone:765-453-0291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009183B261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental