Provider Demographics
NPI:1154311421
Name:DOTSON, PHILLIP LEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:LEN
Last Name:DOTSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 S LANE CT
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7645
Mailing Address - Country:US
Mailing Address - Phone:615-832-5555
Mailing Address - Fax:
Practice Address - Street 1:1290 1ST AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-2762
Practice Address - Country:US
Practice Address - Phone:931-762-3409
Practice Address - Fax:931-762-3488
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0000003961122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN014505OtherTN CARE PROVIDER FACILITY
0044087OtherBLUECROSSBLUESHIELD