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Individual
LARRE L BETSWORTH
Active
Individual
LARRE L BETSWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6550
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22957
BLUECROSS BLUE SHIELD
KS
01
—
785405
UNITED CONCORDIA-TRICARE
—
Enumeration date
06/15/2005
Last updated
11/15/2010
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