Botros & Nguyen Dental Corp

Primary specialty

DentistTaxonomy code 122300000X

License

45093 Issued in CA

Legal business name

BOTROS & NGUYEN DENTAL CORP

Practice address

2502 S Bristol St
Santa Ana, CA 92704

Phone

(714) 754-1888

Fax

(714) 754-0888

NPI assigned

Dec 14, 2006

Organization subpart

No

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

Authorized official

Name

Samer F Botros

Title

General Manager

Phone

(714) 754-1888

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Crystal Smile Dental Doing business as

Locations

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174685382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2502 S BRISTOL ST",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "92704",
            "telephone_number": "714-754-1888",
            "fax_number": "714-754-0888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2502 S BRISTOL ST",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "92704",
            "telephone_number": "714-754-1888",
            "fax_number": "714-754-0888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOTROS & NGUYEN DENTAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BOTROS",
        "authorized_official_first_name": "SAMER",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "714-754-1888"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "45093",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G9398201",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crystal Smile Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer Borrell, MA, ATC
• Elliot Luis Borrero
• Carmela Borromeo, PT
• Amanda N Borton-Weidner
• Inna Bosh, D.D.S
• Sylvia Botros
• Janice Botzbach, MS, BCBA
• Angela Rose Bouder
• Kellie Bougard -Jordan
• Kevin Bouldin

• Dentist in Santa Ana, CA
• Providers in Santa Ana, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.