Healthcare Provider Details

I. General information

NPI: 1174509509
Provider Name (Legal Business Name): BRIAN WILLIAM BARTLETT DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5314 W FRIENDLY AVE STE B
GREENSBORO NC
27410-4351
US

IV. Provider business mailing address

5314 W FRIENDLY AVE STE B
GREENSBORO NC
27410-4351
US

V. Phone/Fax

Practice location:
  • Phone: 336-855-8900
  • Fax:
Mailing address:
  • Phone: 336-855-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2004011022
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8068
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: