Provider Demographics
NPI:1346355294
Name:BARRINGTON GROVE DENTAL
Entity Type:Organization
Organization Name:BARRINGTON GROVE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT PASSEHL
Authorized Official - Middle Name:E
Authorized Official - Last Name:PASSEHL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-382-0818
Mailing Address - Street 1:1531 S GROVE AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-5211
Mailing Address - Country:US
Mailing Address - Phone:847-382-0818
Mailing Address - Fax:
Practice Address - Street 1:1531 S GROVE AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-5211
Practice Address - Country:US
Practice Address - Phone:847-382-0818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty