| Barry Dental Clinic | |
|
750 Mortimer St Barry IL 62312-1247 | |
| (217) 335-2397 | |
| (217) 335-2398 |
| Full Name | Barry Dental Clinic |
|---|---|
| Speciality | Dentist |
| Location | 750 Mortimer St, Barry, Illinois |
| Authorized Official Name and Position | Stephen T Liesen (DENTIST/OWNER) |
| Authorized Official Contact | 2173352397 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Barry Dental Clinic 750 Mortimer St Barry IL 62312-1247 Ph: (217) 335-2397 | Barry Dental Clinic 750 Mortimer St Barry IL 62312-1247 Ph: (217) 335-2397 |
| NPI Number | 1174794028 |
|---|---|
| Provider Enumeration Date | 03/19/2008 |
| Last Update Date | 10/22/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174794028 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 019021224 (Illinois) | Primary |
Barry Dental Care Plcc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 750 Mortimer St, Barry, IL 62312 Phone: 217-335-2397 Fax: 217-335-2398 |