Provider Demographics
NPI:1073847174
Name:BURREN, BARRY MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:MICHAEL
Last Name:BURREN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-6267
Mailing Address - Country:US
Mailing Address - Phone:847-741-5066
Mailing Address - Fax:
Practice Address - Street 1:1 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-6267
Practice Address - Country:US
Practice Address - Phone:847-741-5066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19-A-145341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice