Organization
BARWELL DENTAL CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SERGIO BURGOS B.S., M.B.A (EXECUTIVE DIRECTOR)
(847) 244-5608
Entity
Organization
Contact information
Practice address
201 LIBERTY ST, WAUKEGAN, IL 60085-6515
(847) 244-5608
Mailing address
201 LIBERTY ST, WAUKEGAN, IL 60085-6515
(847) 244-5608
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101325
PAYEE ID NUMBER
IL
05
—
9175784
—
IL
Enumeration date
01/17/2007
Last updated
08/22/2020
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