Provider Demographics
NPI:1619538022
Name:BETZ, JAMES CHARLES IV (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CHARLES
Last Name:BETZ
Suffix:IV
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 1:907 22ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2536
Mailing Address - Country:US
Mailing Address - Phone:651-233-4795
Mailing Address - Fax:
Practice Address - Street 1:1905 PLAZA DR
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2883
Practice Address - Country:US
Practice Address - Phone:651-686-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice