MEDICARE: DR. PHILIP A. BATSON D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2014016764	MO

General Provider Information

NPI Number	:	1457764185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP A. BATSON D.D.S.

Provider Business Mailing Address
First Line	:	409 VANDIVER DR BLDG 4
Second Line	:	SUITE 101
City	:	COLUMBIA
State	:	MO
Zip	:	65202-3754
Country	:	US
Telephone Number	:	573-875-7071
Fax Number	:	573-875-7072

Provider Business Practice Location Address
First Line	:	409 VANDIVER DR BLDG 4
Second Line	:	SUITE 101
City	:	COLUMBIA
State	:	MO
Zip	:	65202-3754
Country	:	US
Telephone Number	:	573-875-7071
Fax Number	:	573-875-7072

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2014
Last Update Date	:	06/10/2014

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