Provider Demographics
NPI:1346215472
Name:BARON, ELLIOT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:
Last Name:BARON
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 1:45 DUNE RD
Mailing Address - Street 2:
Mailing Address - City:WAYSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-3766
Mailing Address - Country:US
Mailing Address - Phone:732-757-6250
Mailing Address - Fax:732-747-0961
Practice Address - Street 1:50 WALLACE ST
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1861
Practice Address - Country:US
Practice Address - Phone:732-747-0993
Practice Address - Fax:732-747-0961
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI225501223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0046515Medicaid