Provider Demographics
NPI:1831748532
Name:BARANES, BENJAMIN PAUL CHALOM (DMD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:PAUL CHALOM
Last Name:BARANES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7430 E CHAPARRAL RD UNIT 239A
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-7169
Mailing Address - Country:US
Mailing Address - Phone:805-452-8584
Mailing Address - Fax:
Practice Address - Street 1:5225 N 19TH AVE STE C
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2903
Practice Address - Country:US
Practice Address - Phone:602-433-0313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0104861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD010486Medicaid