Individual provider Active NPI

Angie Julieth Betancourt

  • Dentist
  • Fullerton, CA
National Provider Identifier
1356267322
Registry record updated Oct 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D113345 Issued in CA
Practice address
301 N Euclid St
Fullerton, CA 92832-1622
Phone
(661) 627-9979
NPI assigned
Jun 25, 2026
Last updated
Oct 27, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 27, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X CA
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X D113345 CA Primary

Addresses

Primary practice location

301 N Euclid St
Fullerton, CA 92832-1622

Mailing address

24535 Town Center Dr Apt 6202
Santa Clarita, CA 91355-0801
Phone (424) 333-3762

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
D113345CAMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1782345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1793059200000",
    "number": "1356267322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24535 TOWN CENTER DR APT 6202",
            "city": "SANTA CLARITA",
            "state": "CA",
            "postal_code": "913550801",
            "telephone_number": "424-333-3762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 N EUCLID ST",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928321622",
            "telephone_number": "661-627-9979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BETANCOURT",
        "first_name": "ANGIE",
        "middle_name": "JULIETH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-06-25",
        "last_updated": "2026-10-27",
        "certification_date": "2026-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "D113345",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fullerton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2026; 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.