Provider Demographics
NPI:1184038358
Name:TOM L. BARANOWSKI, D.D.S.
Entity Type:Organization
Organization Name:TOM L. BARANOWSKI, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARANOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-386-7740
Mailing Address - Street 1:1011 LAKE ST STE 410
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1129
Mailing Address - Country:US
Mailing Address - Phone:708-386-7740
Mailing Address - Fax:
Practice Address - Street 1:1011 LAKE ST STE 410
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1129
Practice Address - Country:US
Practice Address - Phone:708-386-7740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019022265122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty