Provider Demographics
NPI:1801979190
Name:BARSKY, MAXIM S (DDS)
Entity type:Individual
Prefix:DR
First Name:MAXIM
Middle Name:S
Last Name:BARSKY
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 1:7950 MAIN ST. SUITE 205
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369
Mailing Address - Country:US
Mailing Address - Phone:952-836-1113
Mailing Address - Fax:952-836-1184
Practice Address - Street 1:7950 MAIN ST. SUITE 205
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369
Practice Address - Country:US
Practice Address - Phone:763-561-2273
Practice Address - Fax:763-561-5761
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNG122361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN742317900OtherMA