Otis Jacob Bouwsma, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

18445 Issued in TX

Practice address

4430 E 14TH St Unit C
Brownsville, TX 78521-3364

Phone

(956) 548-0222

NPI assigned

Oct 10, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

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

Practice roles

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

• Abc Family Dental Care

  • Dentist
  • Brownsville, TX
  • NPI 1871831743
  NPD (past)

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401840000000",
    "number": "1679661441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 998",
            "city": "OLMITO",
            "state": "TX",
            "postal_code": "785750998",
            "telephone_number": "956-492-3418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4430 E 14TH ST UNIT C",
            "city": "BROWNSVILLE",
            "state": "TX",
            "postal_code": "785213364",
            "telephone_number": "956-548-0222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUWSMA",
        "first_name": "OTIS",
        "middle_name": "JACOB",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2014-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "18445",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "18445",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Juan Gonzalo Borboa
• Dora Gutierrez Borgo, PTA
• Jose Antonio Bossolo Jr., M.D.
• Katia Starlenis Bossous
• Elizabeth Ann Botello, D.D.S.
• Lisa A Bowen-Bender, APRN
• Kasey Amber Bowen
• Boys & Girls Pediatric Clinic PA
• Boys & Girls Urgent Care P. a.
• Bradley W Nordyke MD

• General Practice Dentistry in Brownsville, TX
• Providers in Brownsville, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2014; 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.