Provider Demographics
NPI:1407002538
Name:ASIA I.BELTRAN DDS, PC
Entity Type:Organization
Organization Name:ASIA I.BELTRAN DDS, PC
Other - Org Name:IMPRESSIONS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASIA
Authorized Official - Middle Name:BELTRAN
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-501-2495
Mailing Address - Street 1:3270 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1602
Mailing Address - Country:US
Mailing Address - Phone:773-698-6983
Mailing Address - Fax:773-698-6425
Practice Address - Street 1:3270 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1602
Practice Address - Country:US
Practice Address - Phone:773-698-6983
Practice Address - Fax:773-698-6425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-08
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026985122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty