Provider Demographics
NPI:1093832560
Name:BETANCOURT, KAY CUMBEE (DMD, MS)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:CUMBEE
Last Name:BETANCOURT
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 ROYAL PALM PT
Mailing Address - Street 2:SUITE B
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-5200
Mailing Address - Country:US
Mailing Address - Phone:772-567-5981
Mailing Address - Fax:772-567-5011
Practice Address - Street 1:70 ROYAL PALM PT
Practice Address - Street 2:SUITE B
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5200
Practice Address - Country:US
Practice Address - Phone:772-567-5981
Practice Address - Fax:772-567-5011
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3207122300000X
FLDN 144281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist