Provider Demographics
NPI:1114648987
Name:BETGORGIZ, ADORINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADORINA
Middle Name:
Last Name:BETGORGIZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 CHARLOTTE DR APT A-580
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3619
Mailing Address - Country:US
Mailing Address - Phone:408-666-9657
Mailing Address - Fax:
Practice Address - Street 1:5805 CHARLOTTE DR APT A-580
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3619
Practice Address - Country:US
Practice Address - Phone:408-666-9657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107986122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA107986OtherCALIFORNIA DENTAL BOARD