Provider Demographics
NPI:1972756971
Name:BATESVILLE DENTAL CLINIC
Entity type:Organization
Organization Name:BATESVILLE DENTAL CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:J
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-563-7644
Mailing Address - Street 1:113 EUREKA ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-2534
Mailing Address - Country:US
Mailing Address - Phone:662-563-7644
Mailing Address - Fax:662-563-0453
Practice Address - Street 1:113 EUREKA ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-2534
Practice Address - Country:US
Practice Address - Phone:662-563-7644
Practice Address - Fax:662-563-0453
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BATESVILLE DENTAL CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1968-82122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty