Provider Demographics
NPI:1518976133
Name:BATISTAS, THEOFANIY J I
Entity Type:Individual
Prefix:DR
First Name:THEOFANIY
Middle Name:J
Last Name:BATISTAS
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7982 VALDERRAMA CT
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-2825
Mailing Address - Country:US
Mailing Address - Phone:703-754-9335
Mailing Address - Fax:703-754-1784
Practice Address - Street 1:7521 VIRGINIA OAKS DR STE 230
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3831
Practice Address - Country:US
Practice Address - Phone:703-754-7151
Practice Address - Fax:703-754-1784
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010076521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice