Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 4608 | NC |
NPI | 1700900412 |
---|---|
Provider Name | Dr. Jerry L Batten |
First Address | Atlantic Beach, NC 28512-0160 |
Second Address | Morehead City, NC 28557-2918 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0727E | DENTAL CLINIC (01) | NC |
3404471 | (05) | NC |