| Barwell Dental Clinic, Inc. | |
|
201 Liberty St Waukegan IL 60085-6515 | |
| (847) 244-5608 | |
| Not Available |
| Full Name | Barwell Dental Clinic, Inc. |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 201 Liberty St, Waukegan, Illinois |
| Authorized Official Name and Position | Sergio Burgos (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8472445608 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Barwell Dental Clinic, Inc. 201 Liberty St Waukegan IL 60085-6515 Ph: (847) 244-5608 | Barwell Dental Clinic, Inc. 201 Liberty St Waukegan IL 60085-6515 Ph: (847) 244-5608 |
| NPI Number | 1801948237 |
|---|---|
| Provider Enumeration Date | 01/17/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801948237 | NPI | - | NPPES |
| 101325 | Other | IL | PAYEE ID NUMBER |
| 9175784 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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