Provider Demographics
NPI:1285853838
Name:SHOTTS, WAYNE LAMBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:LAMBERT
Last Name:SHOTTS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 OAK CIRCLE DR W
Mailing Address - Street 2:400
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-4252
Mailing Address - Country:US
Mailing Address - Phone:251-666-8904
Mailing Address - Fax:251-666-8905
Practice Address - Street 1:720 OAK CIRCLE DR W
Practice Address - Street 2:400
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-4252
Practice Address - Country:US
Practice Address - Phone:251-666-8904
Practice Address - Fax:251-666-8905
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice