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General NPI Number Information
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NPI Number | 1801948237
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Entity Type | Organization
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Legal Business Name | BARWELL DENTAL CLINIC, INC.
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 201 LIBERTY ST
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City | WAUKEGAN
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State | IL
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Zip | 60085-6515
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Country | US
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Telephone | 847-244-5608
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Fax |
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Provider Business Mailing Address
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Address Line | 201 LIBERTY ST
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City | WAUKEGAN
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State | IL
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Zip | 60085-6515
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Country | US
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Telephone | 847-244-5608
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. SERGIO BURGOS
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Credential | B.S., M.B.A
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Telephone | 847-244-5608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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