| NPI | 1508007717 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON BRYCE BOTTS President/Owner 901-737-2200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: TN DS0000008754) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: BB9917824) | |
| Enumeration Date | 2009-03-18 |
| Last Update Date | 2009-11-06 |