Provider Demographics
NPI:1033095054
Name:BATESVILLE PREMIER DENTAL PLLC
Entity type:Organization
Organization Name:BATESVILLE PREMIER DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:662-563-7821
Mailing Address - Street 1:PO BOX 1200
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-1200
Mailing Address - Country:US
Mailing Address - Phone:662-563-7821
Mailing Address - Fax:662-578-0406
Practice Address - Street 1:160 CRACKER BARRELL DR
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-3031
Practice Address - Country:US
Practice Address - Phone:662-563-7821
Practice Address - Fax:662-578-0406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental