Provider Demographics
NPI:1255545174
Name:BARNETT, MICHAEL STANLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STANLEY
Last Name:BARNETT
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 1:4711 GOLF RD
Mailing Address - Street 2:412
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1224
Mailing Address - Country:US
Mailing Address - Phone:847-679-0555
Mailing Address - Fax:847-324-4992
Practice Address - Street 1:4711 GOLF RD
Practice Address - Street 2:412
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1224
Practice Address - Country:US
Practice Address - Phone:847-679-0555
Practice Address - Fax:847-324-4992
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A12660122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist