Active NPI
Maxwell Baran
- Dentist
- Winslow, AZ
National Provider Identifier
1932840402
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 7615
- Practice address
- 500 N Indiana Ave
Winslow, AZ 86047-2169 - Phone
- (928) 289-4646
- NPI assigned
- Apr 6, 2022
- Last updated
- Dec 5, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 7615 | LA | Primary |
Addresses
Primary practice location
500 N Indiana Ave
Winslow, AZ 86047-2169
Mailing address
9207 Byron Ter
Burke, VA 22015-2037
Phone (703) 389-3567
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250812004787 | LA | Order and Referring Only - Dentist | 5193223782 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7615 | LA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649203200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733356800000",
"number": "1932840402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9207 BYRON TER",
"city": "BURKE",
"state": "VA",
"postal_code": "220152037",
"telephone_number": "703-389-3567"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 N INDIANA AVE",
"city": "WINSLOW",
"state": "AZ",
"postal_code": "860472169",
"telephone_number": "928-289-4646"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BARAN",
"first_name": "MAXWELL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-04-06",
"last_updated": "2024-12-05",
"certification_date": "2024-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "LA",
"license": "7615",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winslow, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.