Provider Demographics
NPI:1952512659
Name:LOTT, JOHN BRISBY SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BRISBY
Last Name:LOTT
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:BRISBY
Other - Last Name:LOTT
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1297 MARLIN RD
Mailing Address - Street 2:771 EAST MALLORY AVENUE
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-5814
Mailing Address - Country:US
Mailing Address - Phone:901-396-6753
Mailing Address - Fax:901-346-7772
Practice Address - Street 1:1297 MARLIN RD
Practice Address - Street 2:771 EAST MALLORY AVENUE
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-5814
Practice Address - Country:US
Practice Address - Phone:901-396-6753
Practice Address - Fax:901-346-7772
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0050741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice