# BOTTS DENTAL SPA PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508007717
- **Authorized official:** DR. JASON BRYCE BOTTS DDS (PRESIDENT/OWNER)
- **Authorized official phone:** (901) 737-2200

## Contact information

- **Practice address:** 1055 N. HOUSTON LEVEE RD., SUITE 102, CORDOVA, TN 38018-6689
- **Practice address phone:** (901) 737-2200
- **Practice address fax:** (901) 737-2277
- **Mailing address:** 1055 N. HOUSTON LEVEE RD., SUITE 102, CORDOVA, TN 38018-6689
- **Mailing address phone:** (901) 737-2200
- **Mailing address fax:** (901) 737-2277

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | — |
| 1223G0001X | General Practice Dentistry | — | — | — |
| 261QD0000X | Dental Clinic/Center | DS0000008754 | TN | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | BB9917824 | NULL | — |

## Other

- **Enumeration date:** 03/18/2009
- **Last updated:** 11/06/2009