Provider Demographics
NPI:1508139064
Name:BETANCOR, ANETTE
Entity Type:Individual
Prefix:
First Name:ANETTE
Middle Name:
Last Name:BETANCOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANETTE
Other - Middle Name:
Other - Last Name:BETANCOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:10115 SW 143RD PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6988
Mailing Address - Country:US
Mailing Address - Phone:786-376-0633
Mailing Address - Fax:
Practice Address - Street 1:10115 SW 143RD PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6988
Practice Address - Country:US
Practice Address - Phone:786-376-0633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN195841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice