Armin Boutehsaz, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

16564 Issued in MD

Practice address

1253 W Pratt St
Baltimore, MD 21223-2684

Phone

(410) 727-4746

Fax

(410) 727-6767

NPI assigned

Jul 5, 2018

Last updated

Sep 18, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Michael G Pharris OD PC

  dba Adventure Dental and Vision

  • Optometrist
  • Baltimore, MD
  • NPI 1205006145
  NPD (past)
• Ronald B Montano DDS PC

  dba Adventure Dental and Vision

  • General Practice Dentistry
  • Baltimore, MD
  • NPI 1629251228
  NPD (past)

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

{
    "created_epoch": "1530748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568764800000",
    "number": "1073009767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2221 E BIJOU ST STE 100",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809098009",
            "telephone_number": "719-576-1850",
            "fax_number": "719-955-3470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1253 W PRATT ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212232684",
            "telephone_number": "410-727-4746",
            "fax_number": "410-727-6767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUTEHSAZ",
        "first_name": "ARMIN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-07-05",
        "last_updated": "2019-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MD",
            "license": "16564",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "767008700",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADA",
            "identifier": "965375292",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paige R Bourne, DPT
• Douglas Michael Bourque, MD
• Tatiana Bourque
• Don Bousel, M.D.
• Kaitlin Boushell, PT, DPT, CBIS
• George Steven Bova, M.D.
• Eleni Bowden, MS, CCC-SLP
• Shaneca B'Nia Bowden
• Stephen Phillip Bowditch, M.S.
• Alexandra Bowen, MS

• Dentist in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Dentist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2019; 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.