Maggie Azab Bottros, DDS, MS

Primary specialty

DentistTaxonomy code 122300000X

License

2012023477 Issued in MO

Practice address

1389 Sharon Hill LN
Bradbury, CA 91010

Phone

(314) 737-7754

NPI assigned

Dec 4, 2012

Last updated

Sep 8, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Maggie Azab Bottros Other name

Medicare fee-for-service enrollment

Enrolled in CA

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

Credentials

Master of Science

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.

• Fulbright Dental Group, PC

  • General Practice Dentistry
  • Los Angeles, CA
  • NPI 1336384619
  Medicare reassignment NPD
• Lumina Healthcare, LLC

  • General Practice Dentistry
  • Los Angeles, CA
  • NPI 1932343589
  NPD (past)

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

{
    "created_epoch": "1354579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694131200000",
    "number": "1760727648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1389 SHARON HILL LN",
            "city": "BRADBURY",
            "state": "CA",
            "postal_code": "91010",
            "telephone_number": "314-737-7754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1389 SHARON HILL LN",
            "city": "BRADBURY",
            "state": "CA",
            "postal_code": "91010",
            "telephone_number": "314-737-7754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOTTROS",
        "first_name": "MAGGIE",
        "middle_name": "AZAB",
        "name_prefix": "Dr.",
        "credential": "DDS, MS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-12-04",
        "last_updated": "2023-09-08",
        "certification_date": "2023-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2012023477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MAGGIE",
            "last_name": "AZAB BOTTROS",
            "prefix": "DR.",
            "credential": "DDS, MS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Bob Chiang MD Inc
• Bob Chiang, M.D.
• D'Veal Family and Youth Services (DFYS Royal Oaks STEM Acad)
• Lisa Marie Elazegui, PHARMD

• Dentist in Bradbury, CA
• Providers in Bradbury, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2023; 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.