Provider Demographics
NPI:1619024775
Name:BOUTROS, ATEF ABDELMALEK (DDS)
Entity Type:Individual
Prefix:DR
First Name:ATEF
Middle Name:ABDELMALEK
Last Name:BOUTROS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1183 E ANAHEIM STREET
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813
Mailing Address - Country:US
Mailing Address - Phone:562-912-4367
Mailing Address - Fax:562-912-4369
Practice Address - Street 1:1183 E ANAHEIM STREET
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813
Practice Address - Country:US
Practice Address - Phone:562-912-4367
Practice Address - Fax:562-912-4369
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA482341223G0001X
CAD482341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice