Provider Demographics
NPI:1760727648
Name:BOTTROS, MAGGIE AZAB (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MAGGIE
Middle Name:AZAB
Last Name:BOTTROS
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:MAGGIE
Other - Middle Name:
Other - Last Name:AZAB BOTTROS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:1389 SHARON HILL LN
Mailing Address - Street 2:
Mailing Address - City:BRADBURY
Mailing Address - State:CA
Mailing Address - Zip Code:91010
Mailing Address - Country:US
Mailing Address - Phone:314-737-7754
Mailing Address - Fax:
Practice Address - Street 1:1389 SHARON HILL LN
Practice Address - Street 2:
Practice Address - City:BRADBURY
Practice Address - State:CA
Practice Address - Zip Code:91010
Practice Address - Country:US
Practice Address - Phone:314-737-7754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012023477122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist