Provider Demographics
NPI:1326673518
Name:BARTHOLOMEW, JUSTIN DAVID
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:DAVID
Last Name:BARTHOLOMEW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 WILLIAMS TRACE BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4440
Mailing Address - Country:US
Mailing Address - Phone:813-334-5601
Mailing Address - Fax:
Practice Address - Street 1:2225 WILLIAMS TRACE BLVD STE 111
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4440
Practice Address - Country:US
Practice Address - Phone:813-334-5601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-08
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37146122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty