MEDICARE: DR. TARKIS BERNARD BARSAMIAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3136	WI

General Provider Information

NPI Number	:	1063564755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TARKIS BERNARD BARSAMIAN DDS

Provider Business Mailing Address
First Line	:	161 W SUNSET DR STE 202
Second Line	:
City	:	WAUKESHA
State	:	WI
Zip	:	53189-7674
Country	:	US
Telephone Number	:	262-544-1100
Fax Number	:	262-544-1572

Provider Business Practice Location Address
First Line	:	161 W SUNSET DR STE 202
Second Line	:
City	:	WAUKESHA
State	:	WI
Zip	:	53189-7674
Country	:	US
Telephone Number	:	262-544-1100
Fax Number	:	262-544-1572

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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