Provider Demographics
NPI:1861602997
Name:BETLYON, ALEXANDRA OULD (DMD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:OULD
Last Name:BETLYON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 HAYMAKER RD
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-6944
Mailing Address - Country:US
Mailing Address - Phone:814-861-8288
Mailing Address - Fax:
Practice Address - Street 1:266 HOGAN BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:MILL HALL
Practice Address - State:PA
Practice Address - Zip Code:17751-1928
Practice Address - Country:US
Practice Address - Phone:570-748-5552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029410R122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist