MEDICARE: DR. LAURA BETANCUR DMD

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	30266	FL

General Provider Information

NPI Number	:	1912790411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA BETANCUR DMD

Provider Business Mailing Address
First Line	:	10770 NW 26TH PL
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33322-1006
Country	:	US
Telephone Number	:	954-701-7095
Fax Number	:

Provider Business Practice Location Address
First Line	:	8016 SUMMERLIN LAKES DR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1817
Country	:	US
Telephone Number	:	239-482-2722
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2025
Last Update Date	:	05/27/2025

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