Healthcare Provider Details

I. General information

NPI: 1063199057
Provider Name (Legal Business Name): JULIETE K BETANCOURT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18244 NW 27TH AVE
MIAMI GARDENS FL
33056-3501
US

IV. Provider business mailing address

13922 SW 52ND ST
MIRAMAR FL
33027-5955
US

V. Phone/Fax

Practice location:
  • Phone: 305-454-0911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: