Provider Demographics
NPI:1053429795
Name:LOTT, GARY GENE (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:GENE
Last Name:LOTT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:ALVA
Mailing Address - State:OK
Mailing Address - Zip Code:73717-2202
Mailing Address - Country:US
Mailing Address - Phone:580-327-3212
Mailing Address - Fax:580-327-3009
Practice Address - Street 1:515 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:ALVA
Practice Address - State:OK
Practice Address - Zip Code:73717-2202
Practice Address - Country:US
Practice Address - Phone:580-327-3212
Practice Address - Fax:580-327-3009
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK35581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice