Provider Demographics
NPI:1689883829
Name:BELTRAN, FABIO C (DDS)
Entity Type:Individual
Prefix:DR
First Name:FABIO
Middle Name:C
Last Name:BELTRAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1716 HARFORD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-2699
Mailing Address - Country:US
Mailing Address - Phone:410-877-3818
Mailing Address - Fax:410-877-0651
Practice Address - Street 1:1716 HARFORD RD STE 100
Practice Address - Street 2:
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-2699
Practice Address - Country:US
Practice Address - Phone:410-877-3818
Practice Address - Fax:410-877-0651
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice