MEDICARE: DR. ERNEST GRAHAM LOTT DMD

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	6202	FL

General Provider Information

NPI Number	:	1871713040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERNEST GRAHAM LOTT DMD

Provider Business Mailing Address
First Line	:	9141 CYPRESS GREEN DRIVE
Second Line	:	SUITE 4
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-2006
Country	:	US
Telephone Number	:	904-737-1232
Fax Number	:	904-737-0477

Provider Business Practice Location Address
First Line	:	9141 CYPRESS GREEN DRIVE
Second Line	:	SUITE 4
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-2006
Country	:	US
Telephone Number	:	904-737-1232
Fax Number	:	904-737-0477

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

Provider Enumeration Date	:	04/27/2007
Last Update Date	:	07/08/2007

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