Provider Demographics
NPI:1922727684
Name:BETZIOS, ELIANA MARIA (DMD)
Entity Type:Individual
Prefix:
First Name:ELIANA
Middle Name:MARIA
Last Name:BETZIOS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3051 E FRANKLIN BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-7239
Mailing Address - Country:US
Mailing Address - Phone:704-691-0208
Mailing Address - Fax:
Practice Address - Street 1:3051 E FRANKLIN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-7239
Practice Address - Country:US
Practice Address - Phone:704-691-0208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC129881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice