MEDICARE: DR. PHILLIP LEN DOTSON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DS0000003961	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	014505	OTHER	TN	TN CARE PROVIDER FACILITY
2	0044087	OTHER		BLUECROSSBLUESHIELD

General Provider Information

NPI Number	:	1154311421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILLIP LEN DOTSON DDS

Provider Business Mailing Address
First Line	:	917 S LANE CT
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7645
Country	:	US
Telephone Number	:	615-832-5555
Fax Number	:

Provider Business Practice Location Address
First Line	:	1290 1ST AVE
Second Line	:
City	:	LAWRENCEBURG
State	:	TN
Zip	:	38464-2762
Country	:	US
Telephone Number	:	931-762-3409
Fax Number	:	931-762-3488

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	07/08/2007

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