MEDICARE: DR. DAMIAN BETANCOURT DDS

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	122300000X	Dentist	2631	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699813865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAMIAN BETANCOURT DDS

Provider Business Mailing Address
First Line	:	2250 S RANCHO DR STE 205
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4456
Country	:	US
Telephone Number	:	702-291-2031
Fax Number	:	702-984-7566

Provider Business Practice Location Address
First Line	:	5892 LOSEE RD STE 135
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-6200
Country	:	US
Telephone Number	:	702-399-8700
Fax Number	:	702-657-6817

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

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	07/21/2022

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