Provider Demographics
NPI:1447272596
Name:BETZ, DIANE C (DENTAL HYGIENIST)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:C
Last Name:BETZ
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 GREENTREE PKWY
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31220-3636
Mailing Address - Country:US
Mailing Address - Phone:478-327-8487
Mailing Address - Fax:478-327-8313
Practice Address - Street 1:655 7TH ST
Practice Address - Street 2:78TH MDG/SGHC
Practice Address - City:ROBINS AFB
Practice Address - State:GA
Practice Address - Zip Code:31098-2227
Practice Address - Country:US
Practice Address - Phone:478-327-8487
Practice Address - Fax:478-327-8313
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADH001891124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist