Provider Demographics
NPI:1699813865
Name:BETANCOURT, DAMIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAMIAN
Middle Name:
Last Name:BETANCOURT
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 1:2250 S RANCHO DR STE 205
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-4456
Mailing Address - Country:US
Mailing Address - Phone:702-291-2031
Mailing Address - Fax:702-984-7566
Practice Address - Street 1:5892 LOSEE RD STE 135
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-6200
Practice Address - Country:US
Practice Address - Phone:702-399-8700
Practice Address - Fax:702-657-6817
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2631122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1699813865Medicaid