Provider Demographics
NPI:1023171956
Name:BETTMAN, ROBERT GEORGE (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GEORGE
Last Name:BETTMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 E GRAND RIVER AVE
Mailing Address - Street 2:STE 212
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912
Mailing Address - Country:US
Mailing Address - Phone:517-485-1769
Mailing Address - Fax:517-482-7440
Practice Address - Street 1:2909 E GRAND RIVER AVE
Practice Address - Street 2:STE 212
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912
Practice Address - Country:US
Practice Address - Phone:517-485-1769
Practice Address - Fax:517-482-7440
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI134181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice