Healthcare Provider Details

I. General information

NPI: 1972009801
Provider Name (Legal Business Name): JONATHAN BATLLE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2018
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HIGH ST LOWR LEVEL
WESTWOOD MA
02090-1196
US

IV. Provider business mailing address

1 NASSAU ST UNIT 1005
BOSTON MA
02111-1592
US

V. Phone/Fax

Practice location:
  • Phone: 781-733-9378
  • Fax:
Mailing address:
  • Phone: 352-222-0714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1858048
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN1858048
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: