Healthcare Provider Details

I. General information

NPI: 1962522334
Provider Name (Legal Business Name): BARTON & SHAW PERIODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 N MAYFAIR RD STE 340
WAUWATOSA WI
53226-1309
US

IV. Provider business mailing address

2600 N MAYFAIR RD STE 340
WAUWATOSA WI
53226-1309
US

V. Phone/Fax

Practice location:
  • Phone: 414-259-0660
  • Fax: 414-259-0819
Mailing address:
  • Phone: 414-259-0660
  • Fax: 414-259-0819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number5001735
License Number StateWV

VIII. Authorized Official

Name: DR. NANCY S. BARTON
Title or Position: PRESIDENT
Credential: DDS
Phone: 414-259-0660