Healthcare Provider Details

I. General information

NPI: 1124746011
Provider Name (Legal Business Name): ALEX BETANCOURT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2022
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8721 WADSWORTH BLVD STE A
ARVADA CO
80003-0920
US

IV. Provider business mailing address

1106 CRAFTWAY CT
KNIGHTDALE NC
27545-7641
US

V. Phone/Fax

Practice location:
  • Phone: 303-463-8570
  • Fax:
Mailing address:
  • Phone: 919-414-5068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number00206570
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: