MEDICARE: DR. YVETTE N BATTLE DDS, MS

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	019030475	IL
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	021002702	IL

General Provider Information

NPI Number	:	1457584021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YVETTE N BATTLE DDS, MS

Provider Business Mailing Address
First Line	:	3506 S STATE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-1910
Country	:	US
Telephone Number	:	312-429-5533
Fax Number	:

Provider Business Practice Location Address
First Line	:	3506 S STATE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-1910
Country	:	US
Telephone Number	:	312-429-5533
Fax Number	:

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

Provider Enumeration Date	:	08/31/2009
Last Update Date	:	10/23/2020

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