Healthcare Provider Details

I. General information

NPI: 1376661355
Provider Name (Legal Business Name): ERIC MICHAEL BARNES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 E 87TH ST STE B
CHGO IL
60619-7036
US

IV. Provider business mailing address

1335 E 87TH ST STE B
CHGO IL
60619-7036
US

V. Phone/Fax

Practice location:
  • Phone: 773-734-1500
  • Fax: 773-374-6575
Mailing address:
  • Phone: 773-734-1500
  • Fax: 773-374-6575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: