Botts, Jason Bryce

Botts, Jason Bryce is an sole proprietor health care provider with primary practice located at 1055 N Houston Levee Rd Suite 102, Cordova TN 38018-6693. He recently has 2 registered licenses in different health care specialties including Dental Providers / Dentist, Dental Providers / General Practice. Dental Providers / General Practice is his primary health care specialty. Botts, Jason Bryce can be contacted via phone (901) 737-2200.

Contact Information

Primary practice address
1055 N Houston Levee Rd Suite 102 Cordova TN 38018-6693
Phone: (901) 737-2200
Fax: (901) 737-2277
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 3586 Arkansas
Dental Providers / General Practice 1223G0001X DS0000008754 Tennessee

Profile Details

NPI number 1356417687
LBN Legal business name Botts, Jason Bryce
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 28th, 2006
Last updated Apr 23rd, 2009 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1356417687 NPPES
Arkansas MEDICAID 161133608

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