Provider Demographics
NPI:1295006328
Name:BATESVILLE DENTAL
Entity Type:Organization
Organization Name:BATESVILLE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:P
Authorized Official - Last Name:BROUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-934-3651
Mailing Address - Street 1:981 STATE RD., 46 E STE B
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47006-8608
Mailing Address - Country:US
Mailing Address - Phone:812-934-3651
Mailing Address - Fax:812-932-0203
Practice Address - Street 1:981 STATE RD., 46 E STE B
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47006-8608
Practice Address - Country:US
Practice Address - Phone:812-934-3651
Practice Address - Fax:812-932-0203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011136A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty