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Provider Information for 1720224488



DR. JOSE LUIS BELTRAN D.M.D., M.D.

Gender: MALE

Individual NPI: 1720224488

Calendar Last Updated: 2018-01-10

Details

Name Value
NPI 1720224488
Enumeration Date 2008-12-31
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 6003 GRAND PALM DR #717
TAMPA, FL 33647-2671
United States

Phone: 813-442-6162 | Fax: 813-907-9166
View Map External Link
Primary Practice Address 11424 N 56TH ST
TEMPLE TERRACE, FL 33617-2237
United States

Phone: 813-373-4573 | Fax: 813-388-6825
View Map External Link
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist FL DN18552
Other Identifiers
Issuer State Number
Endpoint Information
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location