Provider Demographics
NPI:1336714732
Name:BATTLEFIELD MODERN DENTISTRY LLC
Entity Type:Organization
Organization Name:BATTLEFIELD MODERN DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-283-8421
Mailing Address - Street 1:5469 S STATE HIGHWAY FF
Mailing Address - Street 2:
Mailing Address - City:BATTLEFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65619-9825
Mailing Address - Country:US
Mailing Address - Phone:417-447-5180
Mailing Address - Fax:
Practice Address - Street 1:5469 S STATE HIGHWAY FF
Practice Address - Street 2:
Practice Address - City:BATTLEFIELD
Practice Address - State:MO
Practice Address - Zip Code:65619-9825
Practice Address - Country:US
Practice Address - Phone:417-447-5180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-26
Last Update Date:2021-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental