MEDICARE: DR. JOHN BRISBY LOTT SR. D.D.S

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	1223G0001X	General Practice Dentistry	DS005074	TN

General Provider Information

NPI Number	:	1952512659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN BRISBY LOTT SR. D.D.S

Provider Business Mailing Address
First Line	:	1297 MARLIN RD
Second Line	:	771 EAST MALLORY AVENUE
City	:	MEMPHIS
State	:	TN
Zip	:	38116-5814
Country	:	US
Telephone Number	:	901-396-6753
Fax Number	:	901-346-7772

Provider Business Practice Location Address
First Line	:	1297 MARLIN RD
Second Line	:	771 EAST MALLORY AVENUE
City	:	MEMPHIS
State	:	TN
Zip	:	38116-5814
Country	:	US
Telephone Number	:	901-396-6753
Fax Number	:	901-346-7772

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	02/08/2026

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