Organization
BOTTS DENTAL SPA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON BRYCE BOTTS DDS (PRESIDENT/OWNER)
(901) 737-2200
Entity
Organization
Contact information
Practice address
1055 N. HOUSTON LEVEE RD., SUITE 102, CORDOVA, TN 38018-6689
(901) 737-2200
(901) 737-2277
Mailing address
1055 N. HOUSTON LEVEE RD., SUITE 102, CORDOVA, TN 38018-6689
(901) 737-2200
(901) 737-2277
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
261QD0000X
Dental Clinic/Center
Primary
DS0000008754
TN
332B00000X
Durable Medical Equipment & Medical Supplies
BB9917824
—
Other
Enumeration date
03/18/2009
Last updated
11/06/2009
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