Botts Dental Spa PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

DS0000008754 Issued in TN

Legal business name

BOTTS DENTAL SPA PC

Practice address

1055 N. Houston Levee Rd.
Suite 102
Cordova, TN 38018-6689

Phone

(901) 737-2200

Fax

(901) 737-2277

NPI assigned

Mar 18, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jason Bryce Botts, DDSNPI 1356417687

Title

President/Owner

Phone

(901) 737-2200

Specialties & licenses 3

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jason Bryce Botts, DDS

  • General Practice Dentistry
  • Cordova, TN
  • NPI 1356417687
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1237334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257465600000",
    "number": "1508007717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 N. HOUSTON LEVEE RD.",
            "address_2": "SUITE 102",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380186689",
            "telephone_number": "901-737-2200",
            "fax_number": "901-737-2277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 N. HOUSTON LEVEE RD.",
            "address_2": "SUITE 102",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380186689",
            "telephone_number": "901-737-2200",
            "fax_number": "901-737-2277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOTTS DENTAL SPA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-18",
        "last_updated": "2009-11-06",
        "status": "A",
        "authorized_official_last_name": "BOTTS",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "BRYCE",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "901-737-2200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "TN",
            "license": "DS0000008754",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": "BB9917824",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Naima Bomani, RBT
• Gabrielle Alexia Bonner
• Born by Grace
• Amanda Bostick
• Antoinette Boston
• Jason Bryce Botts, DDS
• Natalie Boucher, PHARMD
• Wissal Miloud Boudaoud
• Bound by Happiness
• Mana Boushehri, O.D.

• Dental Clinic/Center in Cordova, TN
• Providers in Cordova, TN by specialty
• Dental Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.