Provider Demographics
NPI:1063621902
Name:PARTLOW, GEOFFREY ANDREWS II (DMD)
Entity type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:ANDREWS
Last Name:PARTLOW
Suffix:II
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1001 N BEADLE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-1150
Mailing Address - Country:US
Mailing Address - Phone:618-457-2626
Mailing Address - Fax:618-549-1512
Practice Address - Street 1:1001 N BEADLE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1150
Practice Address - Country:US
Practice Address - Phone:618-457-2626
Practice Address - Fax:618-549-1512
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice