Provider Demographics
NPI:1700900412
Name:BATTEN, JERRY L (DDS, MPH)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:L
Last Name:BATTEN
Suffix:
Gender:M
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28512-0160
Mailing Address - Country:US
Mailing Address - Phone:252-808-7080
Mailing Address - Fax:
Practice Address - Street 1:3820 BRIDGES ST
Practice Address - Street 2:SUITE A
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-2918
Practice Address - Country:US
Practice Address - Phone:252-728-8550
Practice Address - Fax:252-222-7739
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC46081223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0727EOtherDENTAL CLINIC
NC3404471Medicaid