Provider Demographics
NPI:1558450791
Name:MOTT, CHRIS ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:ANTHONY
Last Name:MOTT
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 1:631 MILAM
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-0000
Mailing Address - Country:US
Mailing Address - Phone:318-424-7113
Mailing Address - Fax:318-424-7350
Practice Address - Street 1:631 MILAM
Practice Address - Street 2:SUITE 101
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-0000
Practice Address - Country:US
Practice Address - Phone:318-424-7113
Practice Address - Fax:318-424-7350
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4247122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1OtherDENTIST