Provider Demographics
NPI:1669591806
Name:COLLADO, BETZAIDA M (DMD)
Entity type:Individual
Prefix:DR
First Name:BETZAIDA
Middle Name:M
Last Name:COLLADO
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:CALLE UN
Mailing Address - Street 2:136-B
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-1978
Mailing Address - Country:US
Mailing Address - Phone:787-899-1475
Mailing Address - Fax:787-899-1475
Practice Address - Street 1:CALLE UN
Practice Address - Street 2:136-B
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667-1978
Practice Address - Country:US
Practice Address - Phone:787-899-1475
Practice Address - Fax:787-899-1475
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR25021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice