Provider Demographics
NPI:1073780599
Name:BARRINGTON ORAL & MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:BARRINGTON ORAL & MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WALKER
Authorized Official - Last Name:VAN GILDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-385-4224
Mailing Address - Street 1:101 LIONS DR
Mailing Address - Street 2:SUITE 116
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3181
Mailing Address - Country:US
Mailing Address - Phone:847-382-4224
Mailing Address - Fax:847-382-4487
Practice Address - Street 1:101 LIONS DR
Practice Address - Street 2:SUITE 116
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3181
Practice Address - Country:US
Practice Address - Phone:847-382-4224
Practice Address - Fax:847-382-4487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0210015851223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty