Provider Demographics
NPI:1720241722
Name:BARAN, EVELYN ESCOBEDO (DDS)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:ESCOBEDO
Last Name:BARAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 WALT WHITMAN RD
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2231
Mailing Address - Country:US
Mailing Address - Phone:631-423-5200
Mailing Address - Fax:631-423-8001
Practice Address - Street 1:931 WALT WHITMAN RD
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2231
Practice Address - Country:US
Practice Address - Phone:631-423-5200
Practice Address - Fax:631-423-8001
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP653331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice