Active NPI
Matta Joseph Matta Botrous, D.D.S.
- Dentist
- Beaumont, CA
National Provider Identifier
1114262987
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 62073
- Practice address
- 35894 Anderson St
Beaumont, CA 92223-7409 - Phone
- (714) 650-1661
- NPI assigned
- Dec 6, 2012
- Last updated
- Oct 22, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 62073 | CA | Primary |
Addresses
Primary practice location
35894 Anderson St
Beaumont, CA 92223-7409
Mailing address
35894 Anderson St
Beaumont, CA 92223-7409
Phone (714) 650-1661
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
| License | State | Type | Specialty |
|---|---|---|---|
| 62073 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Matta Botrous DDS Inc | Dentist | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1354752000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1477094400000",
"number": "1114262987",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "35894 ANDERSON ST",
"city": "BEAUMONT",
"state": "CA",
"postal_code": "922237409",
"telephone_number": "714-650-1661"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "35894 ANDERSON ST",
"city": "BEAUMONT",
"state": "CA",
"postal_code": "922237409",
"telephone_number": "714-650-1661"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOTROUS",
"first_name": "MATTA",
"middle_name": "JOSEPH MATTA",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-12-06",
"last_updated": "2016-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "62073",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaumont, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.