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NPI Code Detail

MEDICARE: MISS ASIA BELEN INFANTE BELTRAN DDS

MEDICARE: MISS ASIA BELEN INFANTE BELTRAN 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
11223G0001XGeneral Practice DentistryIL

General Provider Information

NPI Number : 1821007006
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS ASIA BELEN INFANTE BELTRAN DDS
Provider Business Mailing Address
First Line : 1050 W GEORGE ST
Second Line : #310
City : CHICAGO
State : IL
Zip : 60657-4353
Country : US
Telephone Number : 773-501-4295
Fax Number :
Provider Business Practice Location Address
First Line : 4941 N KEDZIE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60625-5009
Country : US
Telephone Number : 773-509-9200
Fax Number : 773-509-9247
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2006
Last Update Date : 07/08/2007

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Directions to “ MISS ASIA BELEN INFANTE BELTRAN DDS” Practice Location

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