Individual provider Active NPI

Yudanis Betancourt-Agramonte

  • General Practice Dentistry
  • Pasadena, TX
National Provider Identifier
1093155954
Registry record updated Nov 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
29178 Issued in TX
Practice address
2515 Strawberry Rd
Pasadena, TX 77502-5101
Phone
(713) 943-9993
NPI assigned
Jun 25, 2013
Last updated
Nov 10, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 29178 TX
General Practice Dentistry 1223G0001X 29178 TX Primary

Addresses

Primary practice location

2515 Strawberry Rd
Pasadena, TX 77502-5101

Mailing address

664 Maxey Rd Apt 91C
Houston, TX 77013-5911
Phone (832) 630-4704

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160119000480 TX Order and Referring Only - DentistPractitioner - Dentist 6305149774

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1372118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510272000000",
    "number": "1093155954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "664 MAXEY RD APT 91C",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770135911",
            "telephone_number": "832-630-4704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2515 STRAWBERRY RD",
            "city": "PASADENA",
            "state": "TX",
            "postal_code": "775025101",
            "telephone_number": "713-943-9993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BETANCOURT-AGRAMONTE",
        "first_name": "YUDANIS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-25",
        "last_updated": "2017-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "29178",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "29178",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pasadena, TX

Sources for this page

Verify at the official NPI Registry.