Provider Demographics
NPI:1720048218
Name:BARTHOLOMEW, WAYNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:
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 1:4211 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-2936
Mailing Address - Country:US
Mailing Address - Phone:773-282-7909
Mailing Address - Fax:774-481-0835
Practice Address - Street 1:4211 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2936
Practice Address - Country:US
Practice Address - Phone:773-282-7909
Practice Address - Fax:774-481-0835
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice