Provider Demographics
NPI:1548886948
Name:BELTRAN, ALEXANDER M (DDS)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:M
Last Name:BELTRAN
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 1:22423 BRIDGEHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-2207
Mailing Address - Country:US
Mailing Address - Phone:832-818-1830
Mailing Address - Fax:
Practice Address - Street 1:18640 FARM TO MARKET RD 1488
Practice Address - Street 2:SUITE I
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354
Practice Address - Country:US
Practice Address - Phone:832-379-5488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX361901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice