Provider Demographics
NPI:1427245273
Name:BETROS, BASHAR (DDS)
Entity type:Individual
Prefix:DR
First Name:BASHAR
Middle Name:
Last Name:BETROS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-2524
Mailing Address - Country:US
Mailing Address - Phone:860-621-2644
Mailing Address - Fax:860-331-8016
Practice Address - Street 1:248 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-2524
Practice Address - Country:US
Practice Address - Phone:860-621-2644
Practice Address - Fax:860-331-8016
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0081941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice