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Organization
OLD ORCHARD PERIODONTICS & IMPLANT DENTISTRY LTD
Active
Organization
OLD ORCHARD PERIODONTICS & IMPLANT DENTISTRY LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID BARACK DDS, PERIODONTIST (OWNER)
(847) 982-0640
Entity
Organization
Contact information
Practice address
4905 OLD ORCHARD SHOPPING CTR, SUITE 310, SKOKIE, IL 60077-1425
(847) 982-0640
(847) 982-0644
Mailing address
4905 OLD ORCHARD CTR STE 310, SKOKIE, IL 60077-4740
(847) 982-0640
(847) 982-0644
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
021001143
IL
1223P0300X
Periodontics
—
IL
Other
Enumeration date
02/09/2007
Last updated
07/29/2026
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