Provider Demographics
NPI:1487774626
Name:BETANCOURT, WINSTON HENRY JR (DMD)
Entity type:Individual
Prefix:DR
First Name:WINSTON
Middle Name:HENRY
Last Name:BETANCOURT
Suffix:JR
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:EL SENORIAL MAIL STATION #630
Mailing Address - Street 2:AVE. WINSTON CHURCHILL 138
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-755-5766
Mailing Address - Fax:787-292-2635
Practice Address - Street 1:CALLE 1 #D-4 FAIR VIEW
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-755-5766
Practice Address - Fax:787-292-2635
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice