Provider Demographics
NPI:1710354055
Name:NADER BOTROS DDS PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:NADER BOTROS DDS PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NADER
Authorized Official - Middle Name:F
Authorized Official - Last Name:BOTROS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-530-7220
Mailing Address - Street 1:10372 WESTMINSTER AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4813
Mailing Address - Country:US
Mailing Address - Phone:714-530-7220
Mailing Address - Fax:
Practice Address - Street 1:10372 WESTMINSTER AVE
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4813
Practice Address - Country:US
Practice Address - Phone:714-530-7220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA450931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty