Philippe B Bautista, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

12010902A Issued in IN

Practice address

434 Patrol Rd Unit 210
Jeffersonville, IN 47130-7718

Phone

(812) 582-7255

Fax

(812) 975-7255

NPI assigned

Aug 31, 2006

Last updated

Dec 6, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Philippe Bautista DMD LLC

  dba PBJ Kids Dentistry

  • Pediatric Dentistry
  • Jeffersonville, IN
  • NPI 1417633348
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701820800000",
    "number": "1053423301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "434 PATROL RD UNIT 210",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "471307718",
            "telephone_number": "812-582-7255",
            "fax_number": "812-975-7255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "434 PATROL RD UNIT 210",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "471307718",
            "telephone_number": "812-582-7255",
            "fax_number": "812-975-7255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUTISTA",
        "first_name": "PHILIPPE",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IN",
            "license": "12010902A",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "KY",
            "license": "7875",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60002904",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DORAL",
            "identifier": "9177122",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brittany Bates, RBT
• Jayme Battaglia-Jennings, LCSW
• Porsha Shauniese Battle, RBT
• Patrick David Bauer, MD
• Shelley I Baute, LCSW
• Warlito Aviles Bautista, MD
• Christopher Baxter
• Lauren Elyse Bayens, LCSW
• BB Borkar PSC
• Allison Brook Beavers, APRN

• Pediatric Dentistry in Jeffersonville, IN
• Providers in Jeffersonville, IN by specialty
• Pediatric Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.