Provider Demographics
NPI:1093155954
Name:BETANCOURT-AGRAMONTE, YUDANIS
Entity Type:Individual
Prefix:
First Name:YUDANIS
Middle Name:
Last Name:BETANCOURT-AGRAMONTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 MAXEY RD APT 91C
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77013-5911
Mailing Address - Country:US
Mailing Address - Phone:832-630-4704
Mailing Address - Fax:
Practice Address - Street 1:2515 STRAWBERRY RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77502-5101
Practice Address - Country:US
Practice Address - Phone:713-943-9993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29178122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist