MEDICARE: DR. BETZAIDA M. COLLADO DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2502	PR

General Provider Information

NPI Number	:	1669591806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETZAIDA M. COLLADO DMD

Provider Business Mailing Address
First Line	:	CALLE UN
Second Line	:	136-B
City	:	LAJAS
State	:	PR
Zip	:	00667-1978
Country	:	US
Telephone Number	:	787-899-1475
Fax Number	:	787-899-1475

Provider Business Practice Location Address
First Line	:	CALLE UN
Second Line	:	136-B
City	:	LAJAS
State	:	PR
Zip	:	00667-1978
Country	:	US
Telephone Number	:	787-899-1475
Fax Number	:	787-899-1475

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/08/2007

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