Individual
DR. JASON BRYCE BOTTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1055 N HOUSTON LEVEE RD, SUITE 102, CORDOVA, TN 38018-6693
(901) 737-2200
(901) 737-2277
Mailing address
1055 N HOUSTON LEVEE RD, SUITE 102, CORDOVA, TN 38018-6693
(901) 737-2200
(901) 737-2277
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
3586
AR
1223G0001X
General Practice Dentistry
Primary
DS0000008754
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
161133608
—
AR
Enumeration date
11/28/2006
Last updated
04/23/2009
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