Provider Demographics
NPI:1376661355
Name:BARNES, ERIC MICHAEL (DDS)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:MICHAEL
Last Name:BARNES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 E 87TH ST
Mailing Address - Street 2:STE B
Mailing Address - City:CHGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-7036
Mailing Address - Country:US
Mailing Address - Phone:773-734-1500
Mailing Address - Fax:773-374-6575
Practice Address - Street 1:1335 E 87TH ST
Practice Address - Street 2:STE B
Practice Address - City:CHGO
Practice Address - State:IL
Practice Address - Zip Code:60619-7036
Practice Address - Country:US
Practice Address - Phone:773-734-1500
Practice Address - Fax:773-374-6575
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist