Provider Demographics
NPI:1669641502
Name:BOCA OROFACIAL PAIN CENTER,PA.
Entity Type:Organization
Organization Name:BOCA OROFACIAL PAIN CENTER,PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESEDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVARO
Authorized Official - Middle Name:
Authorized Official - Last Name:BETANCUR
Authorized Official - Suffix:
Authorized Official - Credentials:DD
Authorized Official - Phone:561-750-6790
Mailing Address - Street 1:3401 N FEDERAL HWY
Mailing Address - Street 2:STE. 101
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6046
Mailing Address - Country:US
Mailing Address - Phone:561-750-6790
Mailing Address - Fax:
Practice Address - Street 1:3401 N FEDERAL HWY
Practice Address - Street 2:STE. 101
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6046
Practice Address - Country:US
Practice Address - Phone:561-750-6790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12267261QD0000X, 261QE0002X, 261QP3300X, 261QR0200X, 261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery