Omar Alejandro Betancourt Ibarra

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

DTP752 Issued in FL

Practice address

406 E Camp Wisdom Rd
Duncanville, TX 75116-2708

Phone

(833) 550-6468

NPI assigned

Jan 31, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1643587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763424000000",
    "number": "1063165157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 E CAMP WISDOM RD",
            "city": "DUNCANVILLE",
            "state": "TX",
            "postal_code": "751162708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 E CAMP WISDOM RD",
            "city": "DUNCANVILLE",
            "state": "TX",
            "postal_code": "751162708",
            "telephone_number": "833-550-6468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BETANCOURT IBARRA",
        "first_name": "OMAR",
        "middle_name": "ALEJANDRO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-01-31",
        "last_updated": "2025-11-18",
        "certification_date": "2025-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "FL",
            "license": "DTP752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://app.protectedtrust.com",
            "affiliation": "N",
            "endpointDescription": "encrypted email",
            "address_1": "5491 Dolphin Point Boulevard",
            "city": "Jacksonville",
            "state": "FL",
            "country_code": "US",
            "postal_code": "32211",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Baylor Surgicare at Duncanville LLC
• Donta Sherrell Bennett, DC
• Neethu Benny, MD
• Erika Benston
• Melonee Monique Berry, LPC-A
• Beyond Hospice LLC
• Emily Kay Black, PA-C
• Dana Blough, BCBA
• Blue Sky Health
• Scott Edward Bouley, DC

• Orthodontics and Dentofacial Orthopedics Dentistry in Duncanville, TX
• Providers in Duncanville, TX by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.