Provider Demographics
NPI:1982767125
Name:JEANNE L BARSS DDS MS PA
Entity Type:Organization
Organization Name:JEANNE L BARSS DDS MS PA
Other - Org Name:JEANNE L BARSS DDS MS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BARSS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MSD
Authorized Official - Phone:763-694-6158
Mailing Address - Street 1:3475 PLYMOUTH BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447
Mailing Address - Country:US
Mailing Address - Phone:763-694-6158
Mailing Address - Fax:763-577-1375
Practice Address - Street 1:3475 PLYMOUTH BLVD
Practice Address - Street 2:ST 200
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447
Practice Address - Country:US
Practice Address - Phone:763-694-6158
Practice Address - Fax:763-577-1375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND96871223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty