MEDICARE: ASIA I.BELTRAN DDS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019026985	IL

General Provider Information

NPI Number	:	1407002538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASIA I.BELTRAN DDS, PC

Provider Business Mailing Address
First Line	:	3270 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1602
Country	:	US
Telephone Number	:	773-698-6983
Fax Number	:	773-698-6425

Provider Business Practice Location Address
First Line	:	3270 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1602
Country	:	US
Telephone Number	:	773-698-6983
Fax Number	:	773-698-6425

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. ASIA BELTRAN GARCIA
Credential	:	DDS
Telephone Number	:	773-501-2495

Provider Enumeration Date	:	08/08/2008
Last Update Date	:	12/30/2019

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