Healthcare Provider Details

I. General information

NPI: 1427670421
Provider Name (Legal Business Name): BRACES BY BARNES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ASHLEY BARNES
Title or Position: OWNER
Credential:
Phone: 773-734-1500