Barwell Dental Clinic, Inc.

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

BARWELL DENTAL CLINIC, INC.

Practice address

201 Liberty St
Waukegan, IL 60085-6515

Phone

(847) 244-5608

NPI assigned

Jan 17, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Sergio Burgos, B.S., M.B.A

Title

Executive Director

Phone

(847) 244-5608

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1801948237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 LIBERTY ST",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600856515",
            "telephone_number": "847-244-5608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 LIBERTY ST",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600856515",
            "telephone_number": "847-244-5608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BARWELL DENTAL CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BURGOS",
        "authorized_official_first_name": "SERGIO",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "847-244-5608",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "B.S., M.B.A"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PAYEE ID NUMBER",
            "identifier": "101325",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9175784",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dania Barrientos, MSW
• Brandon Barrios
• Jean Barron, CNM
• April Renee Barroso
• Weston John Bartsch, DPT
• Satish Batchu, MD
• Bayside Care Center LP
• Bayside Terrace LLC
• Tahar Baziz
• Ouida Beard

• Dental Clinic/Center in Waukegan, IL
• Providers in Waukegan, IL by specialty
• Dental Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.