Anastasia Adel Boutros, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

108014 Issued in CA

Practice address

4443 Candlewood St
Lakewood, CA 90712-1736

Phone

(562) 634-5042

NPI assigned

Sep 12, 2022

Last updated

Sep 12, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bach Nguyen Dental Corporation

  dba Candlewood Smiles Dental Group

  • General Practice Dentistry
  • Lakewood, CA
  • NPI 1952618183
  NPD (past)

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

{
    "created_epoch": "1662940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662940800000",
    "number": "1962124495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6641 SILENT HARBOR DR",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926482643",
            "telephone_number": "714-926-6249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4443 CANDLEWOOD ST",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "907121736",
            "telephone_number": "562-634-5042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUTROS",
        "first_name": "ANASTASIA",
        "middle_name": "ADEL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-12",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "108014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karin Boresoff
• Askly Borge
• Alexander Joseph Borish, BCBA
• Trinity Bounyavong
• Leland Bourdages
• Jaysen Branch
• Karenkristine Asuncion Bravo
• Andrea Bray
• Christy Brinker
• Charles D Brodsky, D.D.S, M.S.D.

• General Practice Dentistry in Lakewood, CA
• Providers in Lakewood, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 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.