Provider Demographics
NPI:1225322993
Name:KENNETH J. BARKER, D.D.S P.C.
Entity Type:Organization
Organization Name:KENNETH J. BARKER, D.D.S P.C.
Other - Org Name:CLEARLY CARES DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:JEREMY
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-428-0157
Mailing Address - Street 1:836 W NEWPORT AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-2569
Mailing Address - Country:US
Mailing Address - Phone:773-428-0157
Mailing Address - Fax:
Practice Address - Street 1:3235 W ADDISON ST
Practice Address - Street 2:SUITE B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-4328
Practice Address - Country:US
Practice Address - Phone:773-451-9392
Practice Address - Fax:773-451-9398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-30
Last Update Date:2011-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027297122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty