Provider Demographics
NPI:1851978662
Name:BATLLE, DYLAN (DMD)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:BATLLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5210 NW 93RD AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-7809
Mailing Address - Country:US
Mailing Address - Phone:352-222-1602
Mailing Address - Fax:
Practice Address - Street 1:389 SW CHAPEL HILL ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-6921
Practice Address - Country:US
Practice Address - Phone:386-752-1220
Practice Address - Fax:386-438-5118
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13085390200000X
390200000X
FLDN266111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program