Provider Demographics
NPI:1770689572
Name:BARNES, ELLEN MARY (DDS)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARY
Last Name:BARNES
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 1:345 SULLIVAN RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-1465
Mailing Address - Country:US
Mailing Address - Phone:630-892-3993
Mailing Address - Fax:630-892-1583
Practice Address - Street 1:345 SULLIVAN RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1465
Practice Address - Country:US
Practice Address - Phone:630-892-3993
Practice Address - Fax:630-892-1583
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223E0200XDental ProvidersDentistEndodontics