Provider Demographics
NPI:1508827494
Name:BELTRAMI, MARK A (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:BELTRAMI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 CHARLES H DIMMOCK PKWY
Mailing Address - Street 2:SUITE #5
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-2936
Mailing Address - Country:US
Mailing Address - Phone:804-520-4088
Mailing Address - Fax:
Practice Address - Street 1:456 CHARLES H DIMMOCK PKWY
Practice Address - Street 2:SUITE #5
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2936
Practice Address - Country:US
Practice Address - Phone:804-520-4088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401008214122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist