Provider Demographics
NPI:1306036611
Name:BAREKET, SIMONA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SIMONA
Middle Name:
Last Name:BAREKET
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1647 JOHNSON DR
Mailing Address - Street 2:APT 431
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1868
Mailing Address - Country:US
Mailing Address - Phone:847-571-0167
Mailing Address - Fax:
Practice Address - Street 1:1229 N ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2204
Practice Address - Country:US
Practice Address - Phone:773-252-5772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.027316122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist