Provider Demographics
NPI:1982975462
Name:LOTT, CHARLES D (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:D
Last Name:LOTT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 BAYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-6106
Mailing Address - Country:US
Mailing Address - Phone:908-251-5931
Mailing Address - Fax:
Practice Address - Street 1:15 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2110
Practice Address - Country:US
Practice Address - Phone:908-725-0400
Practice Address - Fax:908-725-1148
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI009270001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice