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General NPI Number Information
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NPI Number | 1033095054
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Entity Type | Organization
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Legal Business Name | BATESVILLE PREMIER DENTAL PLLC
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Dates
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Enumeration Date | 08/14/2025
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 160 CRACKER BARRELL DR
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City | BATESVILLE
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State | MS
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Zip | 38606-3031
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Country | US
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Telephone | 662-563-7821
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Fax | 662-578-0406
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Provider Business Mailing Address
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Address Line | PO BOX 1200
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City | BATESVILLE
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State | MS
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Zip | 38606-1200
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Country | US
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Telephone | 662-563-7821
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Fax | 662-578-0406
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. STEPHEN E SULLIVAN
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Credential | DDS
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Telephone | 662-563-7821
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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