Provider Demographics
NPI:1932923083
Name:BATSON, OLIVIA SHEA
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:SHEA
Last Name:BATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8225 ADENLEE AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4825
Mailing Address - Country:US
Mailing Address - Phone:831-444-5712
Mailing Address - Fax:
Practice Address - Street 1:VIA GIORGIO CORBETTA, 17
Practice Address - Street 2:
Practice Address - City:VICNEZA
Practice Address - State:VICENZA
Practice Address - Zip Code:36100
Practice Address - Country:IT
Practice Address - Phone:044-461-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402208503124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist