Provider Demographics
NPI:1679839203
Name:BOTT DENTISTRY, PLLC
Entity Type:Organization
Organization Name:BOTT DENTISTRY, PLLC
Other - Org Name:BOTT FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:LONNIE
Authorized Official - Last Name:BOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:469-441-2577
Mailing Address - Street 1:1223 SOUTH WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:PILOT POINT
Mailing Address - State:TX
Mailing Address - Zip Code:76258
Mailing Address - Country:US
Mailing Address - Phone:940-686-2535
Mailing Address - Fax:940-686-2158
Practice Address - Street 1:1223 SOUTH WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:PILOT POINT
Practice Address - State:TX
Practice Address - Zip Code:76258
Practice Address - Country:US
Practice Address - Phone:940-686-2535
Practice Address - Fax:940-686-2158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX255901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty