Provider Demographics
NPI:1629153317
Name:GOTTFRIED, BETTY A (DDS)
Entity Type:Individual
Prefix:DR
First Name:BETTY
Middle Name:A
Last Name:GOTTFRIED
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1946 WILTON DR
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-3909
Mailing Address - Country:US
Mailing Address - Phone:954-565-7666
Mailing Address - Fax:954-565-7414
Practice Address - Street 1:1946 WILTON DR
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-3909
Practice Address - Country:US
Practice Address - Phone:954-565-7666
Practice Address - Fax:954-565-7414
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLD133921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice