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General NPI Number Information
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NPI Number | 1720224488
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Entity Type | Individual
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Provider Name | JOSE LUIS BELTRAN D.M.D., M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/31/2008
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Last Update Date | 01/10/2018
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Provider Practice Location Address
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Address Line | 11424 N 56TH ST
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City | TEMPLE TERRACE
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State | FL
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Zip | 33617-2237
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Country | US
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Telephone | 813-373-4573
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Fax | 813-388-6825
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Provider Business Mailing Address
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Address Line | 6003 GRAND PALM DR #717
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City | TAMPA
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State | FL
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Zip | 33647-2671
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Country | US
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Telephone | 813-442-6162
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Fax | 813-907-9166
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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 | DN18552
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License Number State | FL
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