Provider Demographics
NPI:1538293154
Name:BETANCOURT, ALINA MARGARITA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALINA
Middle Name:MARGARITA
Last Name:BETANCOURT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 N BROAD ST
Mailing Address - Street 2:STE.6
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-3314
Mailing Address - Country:US
Mailing Address - Phone:908-353-3790
Mailing Address - Fax:908-527-8264
Practice Address - Street 1:570 N BROAD ST
Practice Address - Street 2:STE.6
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-3314
Practice Address - Country:US
Practice Address - Phone:908-353-3790
Practice Address - Fax:908-527-8264
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 15197122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist