Healthcare Provider Details

I. General information

NPI: 1548425390
Provider Name (Legal Business Name): DAVID A BELTRAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 S. HIAWASSEE RD SUITE 201
ORLANDO FL
32835
US

IV. Provider business mailing address

1507 S. HIAWASSEE RD SUITE 201
ORLANDO FL
32835
US

V. Phone/Fax

Practice location:
  • Phone: 407-781-4188
  • Fax: 407-781-4189
Mailing address:
  • Phone: 407-781-4188
  • Fax: 407-781-4189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN17789
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number17789
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number17789
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: