Healthcare Provider Details

I. General information

NPI: 1669443990
Provider Name (Legal Business Name): TIMOTHY SCOTT BARTLETT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 08/06/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1652 N BUSINESS ROUTE 5
CAMDENTON MO
65020-7501
US

IV. Provider business mailing address

PO BOX 777
RICHLAND MO
65556-0777
US

V. Phone/Fax

Practice location:
  • Phone: 877-406-2662
  • Fax: 573-346-7501
Mailing address:
  • Phone: 573-677-4425
  • Fax: 573-723-1474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number015744
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number015744
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: