| Atef Boutros Dds Inc. | |
|
1183 E Anaheim Street Long Beach CA 90813 | |
| (562) 912-4367 | |
| (562) 912-4369 |
| Full Name | Atef Boutros Dds Inc. |
|---|---|
| Speciality | Dentist |
| Location | 1183 E Anaheim Street, Long Beach, California |
| Authorized Official Name and Position | Atef A Boutros (DENTIST) |
| Authorized Official Contact | 5629124367 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Atef Boutros Dds Inc. 1183 E Anaheim Street Long Beach CA 90813 Ph: (562) 912-4367 | Atef Boutros Dds Inc. 1183 E Anaheim Street Long Beach CA 90813 Ph: (562) 912-4367 |
| NPI Number | 1639229099 |
|---|---|
| Provider Enumeration Date | 01/10/2007 |
| Last Update Date | 10/24/2023 |
| Medicare PECOS PAC ID | 1951722057 |
|---|---|
| Medicare Enrollment ID | O20200527003166 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639229099 | NPI | - | NPPES |
| G93926-01 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
| Provider Name | Atef A Boutros |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1619024775 PECOS PAC ID: 5991096752 Enrollment ID: I20200527003202 |
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