Provider Demographics
NPI:1871713040
Name:LOTT, ERNEST GRAHAM (DMD)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:GRAHAM
Last Name:LOTT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9141 CYPRESS GREEN DRIVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2006
Mailing Address - Country:US
Mailing Address - Phone:904-737-1232
Mailing Address - Fax:904-737-0477
Practice Address - Street 1:9141 CYPRESS GREEN DRIVE
Practice Address - Street 2:SUITE 4
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-2006
Practice Address - Country:US
Practice Address - Phone:904-737-1232
Practice Address - Fax:904-737-0477
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6202122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist