Healthcare Provider Details

I. General information

NPI: 1215022249
Provider Name (Legal Business Name): MICHAEL ANDREW BARON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 EAST MAIN STREET
BRANFORD CT
06405
US

IV. Provider business mailing address

179 EAST MAIN STREET
BRANFORD CT
06405
US

V. Phone/Fax

Practice location:
  • Phone: 203-488-6616
  • Fax: 203-488-5873
Mailing address:
  • Phone: 203-488-6616
  • Fax: 203-488-5873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number006235
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: