Provider Demographics
NPI:1891869699
Name:DANA L BOTT DDS SC
Entity Type:Organization
Organization Name:DANA L BOTT DDS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-764-4060
Mailing Address - Street 1:9555 S HOWELL AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154
Mailing Address - Country:US
Mailing Address - Phone:414-764-4060
Mailing Address - Fax:
Practice Address - Street 1:9555 S HOWELL AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154
Practice Address - Country:US
Practice Address - Phone:414-764-4060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI37401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty