Provider Demographics
NPI:1508318981
Name:BELTRAN CARREON, CARLOS (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:BELTRAN CARREON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:CARLOS
Other - Middle Name:ERNESTO
Other - Last Name:BELTRAN CARREON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:4275 EXECUTIVE SQ
Mailing Address - Street 2:STE 200
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-9123
Mailing Address - Country:US
Mailing Address - Phone:800-743-3900
Mailing Address - Fax:866-272-6924
Practice Address - Street 1:BLVD BERNARDO O'HIGGINS 6385
Practice Address - Street 2:7
Practice Address - City:TIJUANA
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:22115
Practice Address - Country:MX
Practice Address - Phone:664-380-4639
Practice Address - Fax:866-272-6924
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ6223876122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist