Provider Demographics
NPI:1265726897
Name:BETITA, TIMOTHY ALAN (MD, DDS)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ALAN
Last Name:BETITA
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32241 CROWN VALLEY PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3310
Mailing Address - Country:US
Mailing Address - Phone:949-240-2280
Mailing Address - Fax:949-220-2619
Practice Address - Street 1:32241 CROWN VALLEY PKWY STE 220
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3310
Practice Address - Country:US
Practice Address - Phone:949-240-2280
Practice Address - Fax:949-240-2619
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX300901223S0112X
UT9811800-99211223S0112X
CAA1517091223S0112X
WADENT.DE.606606781223S0112X
CADDS1012141223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery