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General NPI Number Information
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NPI Number | 1215054796
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Entity Type | Organization
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Legal Business Name | JOHN S. BETTINGER DDS, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 06/15/2018
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Provider Practice Location Address
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Address Line | 1417 26TH ST UNIT E
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City | SANTA MONICA
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State | CA
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Zip | 90404
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Country | US
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Telephone | 310-394-7037
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Fax |
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Provider Business Mailing Address
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Address Line | 1417 26TH ST UNIT E
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City | SANTA MONICA
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State | CA
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Zip | 90404-3053
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Country | US
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Telephone | 310-394-7037
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Fax |
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DR. JOHN S BETTINGER
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Credential | DDS
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Telephone | 310-913-4762
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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 | D20059
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License Number State | CA
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