Provider Demographics
NPI:1013994029
Name:BETANCOURT, LUZ A (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUZ
Middle Name:A
Last Name:BETANCOURT
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:#1213 LUIS CABALLER STREET
Mailing Address - Street 2:EL COMANDANTE
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00924
Mailing Address - Country:US
Mailing Address - Phone:787-769-1990
Mailing Address - Fax:787-762-5890
Practice Address - Street 1:#1213 LUIS CABALLER STREET
Practice Address - Street 2:EL COMANDANTE
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-769-1990
Practice Address - Fax:787-762-5890
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice