Provider Demographics
NPI:1124183587
Name:BARRY M. BURREN, D.D.S.,P.C.
Entity Type:Organization
Organization Name:BARRY M. BURREN, D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BURREN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-741-5066
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19-A-145341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty