Provider Demographics
NPI:1417243965
Name:DOLORES J. BARAN D.D.S., P.C.
Entity Type:Organization
Organization Name:DOLORES J. BARAN D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DETIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:JENNY
Authorized Official - Last Name:BARAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-548-1440
Mailing Address - Street 1:1103 N MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-1363
Mailing Address - Country:US
Mailing Address - Phone:248-548-1440
Mailing Address - Fax:248-548-3880
Practice Address - Street 1:1103 N MAIN STREET SUITE A
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067
Practice Address - Country:US
Practice Address - Phone:248-548-1440
Practice Address - Fax:248-548-3880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010150131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty