MEDICARE: BATAVIA DENTAL PC

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

General Provider Information

NPI Number	:	1306796933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BATAVIA DENTAL PC

Provider Business Mailing Address
First Line	:	516 E MAIN ST
Second Line	:
City	:	ST CHARLES
State	:	IL
Zip	:	60174-2133
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 W WILSON ST
Second Line	:
City	:	BATAVIA
State	:	IL
Zip	:	60510-1946
Country	:	US
Telephone Number	:	630-879-1534
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN PERISIN
Credential	:	DMD
Telephone Number	:	309-369-7235

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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Directions to “BATAVIA DENTAL PC ” Practice Location

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