Provider Demographics
NPI:1164759817
Name:AB DENTRISTY INC
Entity Type:Organization
Organization Name:AB DENTRISTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARELY
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:BETANCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-807-6872
Mailing Address - Street 1:10750 NW 66TH ST APT 509
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-3775
Mailing Address - Country:US
Mailing Address - Phone:305-807-6872
Mailing Address - Fax:
Practice Address - Street 1:10750 NW 66TH ST APT 509
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-3775
Practice Address - Country:US
Practice Address - Phone:305-807-6872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental