Provider Demographics
NPI:1043296452
Name:PARRA BETANCOURT, JORGE H (DDS)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:H
Last Name:PARRA BETANCOURT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 MAKALAPA DR
Mailing Address - Street 2:COMPACFLT HEALTH SVC (N01HD) ATTN: PROF AFFAIRS COORD
Mailing Address - City:PEARL HARBOR
Mailing Address - State:HI
Mailing Address - Zip Code:96860-3131
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:250 MAKALAPA DR
Practice Address - Street 2:COMPACFLT HEALTH SVC (N01HD) ATTN: PROF AFFAIRS COORD
Practice Address - City:PEARL HARBOR
Practice Address - State:HI
Practice Address - Zip Code:96860-3131
Practice Address - Country:US
Practice Address - Phone:808-471-2463
Practice Address - Fax:808-474-7806
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5650-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice