Provider Demographics
NPI:1396845467
Name:BETEN, GREGORY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:M
Last Name:BETEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17001 ALBERS AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-4243
Mailing Address - Country:US
Mailing Address - Phone:216-941-5535
Mailing Address - Fax:
Practice Address - Street 1:17001 ALBERS AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-4243
Practice Address - Country:US
Practice Address - Phone:216-941-5535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH200211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341484921OtherEIN