Provider Demographics
NPI:1417906421
Name:BATY, MISTI (DENTIST)
Entity Type:Individual
Prefix:
First Name:MISTI
Middle Name:
Last Name:BATY
Suffix:
Gender:F
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 6TH AVE S
Mailing Address - Street 2:DENTAL ADMINISTRATION
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1502
Mailing Address - Country:US
Mailing Address - Phone:205-930-1422
Mailing Address - Fax:205-930-1448
Practice Address - Street 1:1400 6TH AVE S
Practice Address - Street 2:DENTAL ADMINISTRATION
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1502
Practice Address - Country:US
Practice Address - Phone:205-930-1422
Practice Address - Fax:205-930-1448
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL54261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-99260OtherBLUE CROSS BLUE SHIELD
AL009934643Medicaid
AL51532201OtherBESSEMER- ALL KIDS NUMBER
AL009934642Medicaid
AL009933207Medicaid
AL009934644Medicaid
AL51531994OtherCENTRAL-ALL KIDS NUMBER
AL51532202OtherEASTERN-ALL KIDS NUMBER
AL009934643Medicaid