Provider Demographics
NPI:1205980059
Name:BATOS, IVY (DMD)
Entity type:Individual
Prefix:DR
First Name:IVY
Middle Name:
Last Name:BATOS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34920 RIDGE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-4190
Mailing Address - Country:US
Mailing Address - Phone:440-951-1008
Mailing Address - Fax:440-951-6848
Practice Address - Street 1:34920 RIDGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4190
Practice Address - Country:US
Practice Address - Phone:440-951-1008
Practice Address - Fax:440-951-6848
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH200321223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics