Provider Demographics
NPI:1801109434
Name:OTT, BRIAN CHANDLER (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:CHANDLER
Last Name:OTT
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 1:1751 WINTERBERRY CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8249
Mailing Address - Country:US
Mailing Address - Phone:434-202-2733
Mailing Address - Fax:
Practice Address - Street 1:1769 WORTH PARK
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-7441
Practice Address - Country:US
Practice Address - Phone:434-964-0088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-25
Last Update Date:2010-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014128761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice