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NPI 1558494864

NPI 1558494864 : C WESLEY BARNETT DDS PC : CHICAGO, IL

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General NPI Number Information
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    NPI Number           |    1558494864
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    Entity Type          |    Organization 
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    Legal Business Name  |    C WESLEY BARNETT DDS PC 
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Dates
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    Enumeration Date     |    03/14/2007
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    Last Update Date     |    08/22/2020
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Provider Practice Location Address
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    Address Line         |    29 SOUTH LASALLE STREET SUITE 1020
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    City                 |    CHICAGO
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    State                |    IL
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    Zip                  |    60603
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    Country              |    US
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    Telephone            |    312-726-1155
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    Fax                  |    312-726-1169
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Provider Business Mailing Address
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    Address Line         |    29 SOUTH LASALLE STREET SUITE 1020
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    City                 |    CHICAGO
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    State                |    IL
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    Zip                  |    60603
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    Country              |    US
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    Telephone            |    312-726-1155
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    Fax                  |    312-726-1169
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Authorized Official
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    Title or Position    |    PRESIDENT
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    Name                 |    DR. CLARENCE WESLEY BARNETT 
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    Credential           |    DDS
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    Telephone            |    312-726-1155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    1223G0001X
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    Taxonomy Name        |    General Practice Dentistry
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    License Number       |    
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    License Number State |    IL
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