1982767125 NPI number — JEANNE L BARSS DDS MS PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982767125 NPI number — JEANNE L BARSS DDS MS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEANNE L BARSS DDS MS PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JEANNE L BARSS DDS MS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982767125
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3475 PLYMOUTH BLVD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-694-6158
Provider Business Mailing Address Fax Number:
763-577-1375

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3475 PLYMOUTH BLVD
Provider Second Line Business Practice Location Address:
ST 200
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-694-6158
Provider Business Practice Location Address Fax Number:
763-577-1375
Provider Enumeration Date:
12/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BARSS
Authorized Official First Name:
JEANNE
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
763-694-6158

Provider Taxonomy Codes

  • Taxonomy code: 1223P0300X , with the licence number:  D9687 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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