Provider Demographics
NPI:1902833221
Name:BATLLE, JOHN AMANDO III (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:AMANDO
Last Name:BATLLE
Suffix:III
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 1:389 SW CHAPEL HILL ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-6921
Mailing Address - Country:US
Mailing Address - Phone:386-752-1220
Mailing Address - Fax:386-438-5118
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?:Yes
Enumeration Date:2006-06-26
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN95411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice