Individual
DR. PHILIPPE B BAUTISTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
434 PATROL RD UNIT 210, JEFFERSONVILLE, IN 47130-7718
(812) 582-7255
(812) 975-7255
Mailing address
434 PATROL RD UNIT 210, JEFFERSONVILLE, IN 47130-7718
(812) 582-7255
(812) 975-7255
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
12010902A
IN
1223P0221X
Pediatric Dentistry
7875
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60002904
—
KY
01
—
9177122
DORAL
KY
Enumeration date
08/31/2006
Last updated
12/06/2023
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