Provider Demographics
NPI:1720224488
Name:BELTRAN, JOSE LUIS (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:LUIS
Last Name:BELTRAN
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6003 GRAND PALM DR
Mailing Address - Street 2:#717
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2671
Mailing Address - Country:US
Mailing Address - Phone:813-442-6162
Mailing Address - Fax:813-907-9166
Practice Address - Street 1:11424 N 56TH ST
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-2237
Practice Address - Country:US
Practice Address - Phone:813-373-4573
Practice Address - Fax:813-388-6825
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-31
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18552122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist