Provider Demographics
NPI:1659509453
Name:BETAHARON, ANDREW LOREN (DDS)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:LOREN
Last Name:BETAHARON
Suffix:
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 1:8400 KAY CT
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2206
Mailing Address - Country:US
Mailing Address - Phone:240-338-5995
Mailing Address - Fax:
Practice Address - Street 1:8400 KAY CT
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2206
Practice Address - Country:US
Practice Address - Phone:240-338-5995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD146441223G0001X
VA04014128231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice