Provider Demographics
NPI:1780691360
Name:BATTERTON, SAMUEL SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:SCOTT
Last Name:BATTERTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 ROCKBRIDGE RD
Mailing Address - Street 2:STE 164
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-7042
Mailing Address - Country:US
Mailing Address - Phone:770-921-7047
Mailing Address - Fax:770-921-2640
Practice Address - Street 1:375 ROCKBRIDGE RD
Practice Address - Street 2:STE 164
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-7042
Practice Address - Country:US
Practice Address - Phone:770-921-7047
Practice Address - Fax:770-921-2640
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8932122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist