Healthcare Provider Details

I. General information

NPI: 1861802738
Provider Name (Legal Business Name): ANETTE BETANEOR, DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8372 SW 40 ST
MIAMI FL
33155
US

IV. Provider business mailing address

8372 SW 40 ST
MIAMI FL
33155
US

V. Phone/Fax

Practice location:
  • Phone: 305-553-3683
  • Fax: 305-553-3694
Mailing address:
  • Phone: 305-553-3683
  • Fax: 305-553-3694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDN19584
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN19584
License Number StateFL

VIII. Authorized Official

Name: ANETTE BETANCOR
Title or Position: OWNER
Credential: DDS
Phone: 305-553-3683