Provider Demographics
NPI:1689725723
Name:BARTHOLOMEW, CHRISTOPHER ETHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ETHAN
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 415
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VIEW
Mailing Address - State:TX
Mailing Address - Zip Code:77446-0415
Mailing Address - Country:US
Mailing Address - Phone:936-857-5113
Mailing Address - Fax:936-857-5120
Practice Address - Street 1:528 BUS HWY 290
Practice Address - Street 2:
Practice Address - City:PRAIRIE VIEW
Practice Address - State:TX
Practice Address - Zip Code:77446
Practice Address - Country:US
Practice Address - Phone:936-857-5113
Practice Address - Fax:936-857-5120
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16892122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist