MEDICARE: STEPHANIE MARC CASEQUIN BATISTA

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	1223G0001X	General Practice Dentistry	7548	NV
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1114690849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE MARC CASEQUIN BATISTA

Provider Business Mailing Address
First Line	:	6423 POINT ISABEL WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-7640
Country	:	US
Telephone Number	:	818-384-5407
Fax Number	:

Provider Business Practice Location Address
First Line	:	6765 W RUSSELL RD STE 170
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1862
Country	:	US
Telephone Number	:	702-291-2031
Fax Number	:	702-410-9402

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

Provider Enumeration Date	:	07/28/2021
Last Update Date	:	01/10/2026

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