Provider Demographics
NPI:1548283104
Name:BARATZ, SCOTT J (DMD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:J
Last Name:BARATZ
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 1:1137 STANLEY DOLLAR DR
Mailing Address - Street 2:APT 2
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-2938
Mailing Address - Country:US
Mailing Address - Phone:609-634-4068
Mailing Address - Fax:
Practice Address - Street 1:1137 STANLEY DOLLAR DR
Practice Address - Street 2:APT 2
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94595-2938
Practice Address - Country:US
Practice Address - Phone:609-634-4068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022225L1223G0001X
CA51721122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice