Provider Demographics
NPI:1669888947
Name:GE BARSA DDS LTD.
Entity type:Organization
Organization Name:GE BARSA DDS LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BARSA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-267-9777
Mailing Address - Street 1:3190 N ELSTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-5845
Mailing Address - Country:US
Mailing Address - Phone:773-267-9777
Mailing Address - Fax:
Practice Address - Street 1:3190 N ELSTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-5845
Practice Address - Country:US
Practice Address - Phone:773-267-9777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.029076122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1194156042OtherNPI
IL1497952816OtherNPI
IL1699026302OtherNPI