Provider Demographics
NPI:1194811612
Name:BELTRAN, CARLOS EDWIN (DMD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:EDWIN
Last Name:BELTRAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 CALLE SIERRA MORENA
Mailing Address - Street 2:PMB 627
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-616-8557
Mailing Address - Fax:
Practice Address - Street 1:HP16 CALLE AMALIA PAOLI
Practice Address - Street 2:7MA SECCION
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-3606
Practice Address - Country:US
Practice Address - Phone:787-784-0282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRD-24811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice