Serge Bou Mechrek

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

36816 Issued in TX

Practice address

1502 S Westmoreland Rd
Dallas, TX 75211-5765

Phone

(214) 550-7137

NPI assigned

Sep 24, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Cosmic Dental PLLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Dallas, TX
  • NPI 1275312068
  NPD

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

{
    "created_epoch": "1600905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770681600000",
    "number": "1366059388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1502 S WESTMORELAND RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752115765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 S WESTMORELAND RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752115765",
            "telephone_number": "214-550-7137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOU MECHREK",
        "first_name": "SERGE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-24",
        "last_updated": "2026-02-10",
        "certification_date": "2026-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "36816",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "TX",
            "license": "36816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Haley N Botner, APRN
• Lynn Marie Botta, RDMS
• John T Botts, M.D.
• Laura Botts, AUD
• Miriya Botz
• Blanca Eugenia Bou-Fitzmaurice, M.S. IN COUNSELING
• Adeeb George Bou-Saba, MD
• Katherine Elisabeth Bouchard, DO
• Anna Marie Boucher, RDH
• Margery Dee Elledge Boucher, MA, MS, LPC

• Orthodontics and Dentofacial Orthopedics Dentistry in Dallas, TX
• Providers in Dallas, TX by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.