MEDICARE: DR. SIMONA BAREKET 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	122300000X	Dentist	019.027316	IL

General Provider Information

NPI Number	:	1306036611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIMONA BAREKET DDS

Provider Business Mailing Address
First Line	:	1647 JOHNSON DR
Second Line	:	APT 431
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-1868
Country	:	US
Telephone Number	:	847-571-0167
Fax Number	:

Provider Business Practice Location Address
First Line	:	1229 N ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2204
Country	:	US
Telephone Number	:	773-252-5772
Fax Number	:

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

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

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