Samuel Botros, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

22DI02556100 Issued in NJ

Practice address

711 Avenue C
Bayonne, NJ 07002-5833

Phone

(201) 437-3500

NPI assigned

Jul 27, 2011

Sex

Male

Sole proprietor

No

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 NJ

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

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.

• Seidman,Cohen,Herman,Normane,PA

  • Dentist
  • Bayonne, NJ
  • NPI 1356553556
  NPD (past)
• Aspen Dental Associates of North Eastern PA, PC

  • General Practice Dentistry
  • Scranton, PA
  • NPI 1538386388
  NPD (past)

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

{
    "created_epoch": "1311724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656547200000",
    "number": "1831477645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 AVENUE C",
            "city": "BAYONNE",
            "state": "NJ",
            "postal_code": "070025833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 AVENUE C",
            "city": "BAYONNE",
            "state": "NJ",
            "postal_code": "070025833",
            "telephone_number": "201-437-3500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1516 Scranton Carbondale Hwy",
            "address_purpose": "LOCATION",
            "city": "Scranton",
            "state": "PA",
            "postal_code": "185081136",
            "country_code": "US",
            "telephone_number": "570-383-3200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOTROS",
        "first_name": "SAMUEL",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-27",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "38836",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI02556100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bogdan Orthodontics
• Frank A. Bogdan, D.M.D.
• Jack Boghossian, M.D.
• Ira Bologh, R.PH.
• Lisa Bongiovanni
• Viktouria M Botrous, PHARMD
• Boulevard Medical Office PC
• Mary Ellen Boyle, R.PH.
• Keith Brennan
• Brian C. Della Pesca Ma LPC, LLC

• Dentist in Bayonne, NJ
• Providers in Bayonne, NJ by specialty
• Dentist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2022; 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.