Provider Demographics
NPI:1407409071
Name:BARYSENKA LLC
Entity Type:Organization
Organization Name:BARYSENKA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PIOTR
Authorized Official - Middle Name:
Authorized Official - Last Name:BARYSENKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-406-9898
Mailing Address - Street 1:124 N CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-1402
Mailing Address - Country:US
Mailing Address - Phone:815-895-7660
Mailing Address - Fax:
Practice Address - Street 1:124 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-1402
Practice Address - Country:US
Practice Address - Phone:815-895-7660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty