NPIMap

Organization Active NPI

Matta Botrous DDS Inc

  • Dentist
  • Rancho Cucamonga, CA
National Provider Identifier
1962940874
Registry record updated Feb 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
62073 Issued in CA
Legal business name
MATTA BOTROUS DDS INC
Doing business as
Talent Dental
Practice address
10590 Town Center Dr
Suite # 180
Rancho Cucamonga, CA 91730-0360
Phone
(714) 650-1661
NPI assigned
Feb 10, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2017

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

Authorized official

Name
Dr. Matta Joseph Matta Botrous, DDSNPI 1114262987
Title
President
Phone
(714) 650-1661

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 62073 CA Primary

Addresses

Primary practice location

10590 Town Center Dr
Suite # 180
Rancho Cucamonga, CA 91730-0360

Mailing address

10590 Town Center Dr
Suite # 180
Rancho Cucamonga, CA 91730-0360
Phone (714) 650-1661

Other names 1

  • Talent Dental Doing business as

National Provider Directory

National Provider Directory

Locations

10590 Town Center Dr
Ste 180
Rancho Cucamonga, CA 91730
Phone (714) 650-1661

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1486684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486684800000",
    "number": "1962940874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10590 TOWN CENTER DR",
            "address_2": "SUITE # 180",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917300360",
            "telephone_number": "714-650-1661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10590 TOWN CENTER DR",
            "address_2": "SUITE # 180",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917300360",
            "telephone_number": "714-650-1661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTA BOTROUS DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-10",
        "last_updated": "2017-02-10",
        "status": "A",
        "authorized_official_last_name": "BOTROUS",
        "authorized_official_first_name": "MATTA",
        "authorized_official_middle_name": "JOSEPH MATTA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-650-1661",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "62073",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Talent Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rancho Cucamonga, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.