Provider Demographics
NPI:1710989876
Name:WEBSTER, BARBARA RUSANOWSKY (DDS)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:RUSANOWSKY
Last Name:WEBSTER
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 1:1121 WARREN AVE
Mailing Address - Street 2:STE 130
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-3570
Mailing Address - Country:US
Mailing Address - Phone:630-663-0554
Mailing Address - Fax:630-663-1025
Practice Address - Street 1:1121 WARREN AVE
Practice Address - Street 2:STE 130
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-3570
Practice Address - Country:US
Practice Address - Phone:630-663-0554
Practice Address - Fax:630-663-1025
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2014-10-30
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
IL019-0201691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice