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General NPI Number Information
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NPI Number | 1073279600
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Entity Type | Individual
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Provider Name | JORDAN RYAN BETEL DMD
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Gender | Male
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Dates
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Enumeration Date | 11/09/2021
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Last Update Date | 04/26/2023
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Provider Practice Location Address
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Address Line | 375 6TH ST
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City | DOVER
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State | NH
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Zip | 03820-5935
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Country | US
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Telephone | 603-272-6094
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Fax |
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Provider Business Mailing Address
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Address Line | 424 MANOR RD E
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City | TORONTO
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State | ONTARIO
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Zip | M4S1S8
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Country | CA
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN26531
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 04730
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License Number State | NH
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