Provider Demographics
NPI:1821007006
Name:BELTRAN, ASIA BELEN INFANTE (DDS)
Entity Type:Individual
Prefix:MISS
First Name:ASIA BELEN
Middle Name:INFANTE
Last Name:BELTRAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 W GEORGE ST
Mailing Address - Street 2:#310
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4353
Mailing Address - Country:US
Mailing Address - Phone:773-501-4295
Mailing Address - Fax:
Practice Address - Street 1:4941 N KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-5009
Practice Address - Country:US
Practice Address - Phone:773-509-9200
Practice Address - Fax:773-509-9247
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice