David Barack, D.D.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

021-001202 Issued in IL

Practice address

4905 Old Orchard Shopping Ctr
Suite 310
Skokie, IL 60077-1425

Phone

(847) 982-0640

NPI assigned

Oct 6, 2006

Last updated

Jan 25, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Old Orchard Periodontics & Implant Dentistry LTD

  • Periodontics
  • Skokie, IL
  • NPI 1821139171
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359072000000",
    "number": "1497842132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4905 OLD ORCHARD SHOPPING CTR",
            "address_2": "SUITE 310",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600771425",
            "telephone_number": "847-982-0640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4905 OLD ORCHARD SHOPPING CTR",
            "address_2": "SUITE 310",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600771425",
            "telephone_number": "847-982-0640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARACK",
        "first_name": "DAVID",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-06",
        "last_updated": "2013-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": "021-001202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle L Bandy, M.D.
• Andrew Harrison Bank, MD
• Haley Lynne Banks, NP
• Zina Sholji Banna, MD
• Karla Lund Baptiste, LPC
• Logan Barber, PA-C
• Claire Elyse Bareiss, PA-C
• Breanna Noelle Barker
• Deborah Barker, DDS
• Michael Stanley Barnett, D.D.S.

• Periodontics in Skokie, IL
• Providers in Skokie, IL by specialty
• Periodontics in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.