Healthcare Provider Details

I. General information

NPI: 1164535944
Provider Name (Legal Business Name): BARBARA SIARGOS D.D.S., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 WAVERLY DR
ELGIN IL
60120-4082
US

IV. Provider business mailing address

435 W ERIE ST APT 1906
CHICAGO IL
60610-6989
US

V. Phone/Fax

Practice location:
  • Phone: 847-214-8888
  • Fax: 847-214-8889
Mailing address:
  • Phone: 847-212-7206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: