Provider Demographics
NPI:1457764185
Name:BATSON, PHILIP A (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:A
Last Name:BATSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
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?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist