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Individual

DR. ANNA M BETLEJ

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
5328 COLDWATER RD, FORT WAYNE, IN 46825-5445
(260) 471-5016
Mailing address
5328 COLDWATER RD, FORT WAYNE, IN 46825-5445
(260) 471-5016

Taxonomy

Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
12013698A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
12013698A
STATE DENTAL BOARD
IN
Enumeration date
08/23/2021
Last updated
09/15/2021
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