Provider Demographics
NPI:1295039980
Name:KATHLEEN B BARTH
Entity Type:Organization
Organization Name:KATHLEEN B BARTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BARTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-446-1378
Mailing Address - Street 1:475 CHESTNUT ST.
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093
Mailing Address - Country:US
Mailing Address - Phone:847-446-1378
Mailing Address - Fax:847-446-1214
Practice Address - Street 1:475 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-2438
Practice Address - Country:US
Practice Address - Phone:847-446-1378
Practice Address - Fax:847-446-1412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0186761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty