Provider Demographics
NPI:1083986673
Name:WILLIAM D. BETTIS, DMD, PC
Entity Type:Organization
Organization Name:WILLIAM D. BETTIS, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:BETTIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-673-6344
Mailing Address - Street 1:PO BOX 1668
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-0408
Mailing Address - Country:US
Mailing Address - Phone:541-673-6344
Mailing Address - Fax:541-673-9706
Practice Address - Street 1:1729 W HARVARD AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-2788
Practice Address - Country:US
Practice Address - Phone:541-673-6344
Practice Address - Fax:541-673-9706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD44981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty