Provider Demographics
NPI:1184648917
Name:BETTIS, JOHN BRETT (DMD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:BRETT
Last Name:BETTIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 HIGHWAY 11
Mailing Address - Street 2:SUITE 4
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-2877
Mailing Address - Country:US
Mailing Address - Phone:205-467-2211
Mailing Address - Fax:205-467-9744
Practice Address - Street 1:750 US HIGHWAY 11
Practice Address - Street 2:SUITE 4
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-4391
Practice Address - Country:US
Practice Address - Phone:205-467-2211
Practice Address - Fax:205-467-9744
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL50691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice