Healthcare Provider Details

I. General information

NPI: 1184557910
Provider Name (Legal Business Name): HAYDEN J BARTHOLOMEW DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 BROADWAY ST
LAMAR MO
64759-1224
US

IV. Provider business mailing address

201 WALNUT ST
LAMAR MO
64759-1057
US

V. Phone/Fax

Practice location:
  • Phone: 417-262-6070
  • Fax: 417-262-6071
Mailing address:
  • Phone: 417-451-9450
  • Fax: 417-451-8903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2026022896
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: