Healthcare Provider Details

I. General information

NPI: 1356177158
Provider Name (Legal Business Name): JOHN BATSON OMFS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W CAPITOL AVE
LITTLE ROCK AR
72201-3311
US

IV. Provider business mailing address

PO BOX 734753
DALLAS TX
75373-4753
US

V. Phone/Fax

Practice location:
  • Phone: 501-904-8282
  • Fax:
Mailing address:
  • Phone: 501-904-8282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: PAOLA RAMOS
Title or Position: CREDENTIALING TEAM LEAD
Credential:
Phone: 972-869-3789