Provider Demographics
NPI:1790198422
Name:PHILIP A. BATSON, DDS, LLC
Entity Type:Organization
Organization Name:PHILIP A. BATSON, DDS, LLC
Other - Org Name:COLUMBIA HEALTHY SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SHAREHOLDER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:A
Authorized Official - Last Name:BATSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:573-875-7071
Mailing Address - Street 1:409 VANDIVER DR BLDG 4
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-3754
Mailing Address - Country:US
Mailing Address - Phone:573-875-7071
Mailing Address - Fax:573-875-7072
Practice Address - Street 1:409 VANDIVER DR BLDG 4
Practice Address - Street 2:SUITE 101
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-3754
Practice Address - Country:US
Practice Address - Phone:573-875-7071
Practice Address - Fax:573-875-7072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014016764122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty