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General NPI Number Information
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NPI Number | 1184648917
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Entity Type | Individual
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Provider Name | JOHN BRETT BETTIS DMD
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Gender | Male
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 04/08/2008
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Provider Practice Location Address
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Address Line | 750 US HIGHWAY 11 SUITE 4
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City | TRUSSVILLE
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State | AL
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Zip | 35173-4391
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Country | US
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Telephone | 205-467-2211
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Fax | 205-467-9744
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Provider Business Mailing Address
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Address Line | 750 HIGHWAY 11 SUITE 4
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City | TRUSSVILLE
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State | AL
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Zip | 35173-2877
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Country | US
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Telephone | 205-467-2211
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Fax | 205-467-9744
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5069
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License Number State | AL
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