Provider Demographics
NPI:1609085950
Name:LOTT CUFFIE SOUTHWEST PROPERTIES
Entity Type:Organization
Organization Name:LOTT CUFFIE SOUTHWEST PROPERTIES
Other - Org Name:LAKE OCONEE SMILE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KANETA
Authorized Official - Middle Name:R
Authorized Official - Last Name:LOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:706-454-2222
Mailing Address - Street 1:1050 PARKSIDE COMMONS
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642
Mailing Address - Country:US
Mailing Address - Phone:706-454-2222
Mailing Address - Fax:706-454-1234
Practice Address - Street 1:1050 PARKSIDE COMMONS
Practice Address - Street 2:SUITE 103
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642
Practice Address - Country:US
Practice Address - Phone:706-454-2222
Practice Address - Fax:706-454-1234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0094501223P0221X
GADN0121741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty