Philippe Bautista DMD LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

PHILIPPE BAUTISTA DMD LLC

Practice address

434 Patrol Rd Suite 210
Jeffersonville, IN 47130

Phone

(812) 582-7255

Fax

(812) 975-7255

NPI assigned

Jun 26, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Philippe B Bautista, DMDNPI 1053423301

Title

Owner

Phone

(502) 744-5442

Specialties & licenses 1

Addresses

Other names 1

• PBJ Kids Dentistry Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Philippe B Bautista, DMD

  • Pediatric Dentistry
  • Jeffersonville, IN
  • NPI 1053423301
  NPD Authorized official

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

{
    "created_epoch": "1687737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701820800000",
    "number": "1417633348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "434 PATROL RD SUITE 210",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "47130",
            "telephone_number": "812-582-7255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "434 PATROL RD SUITE 210",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "47130",
            "telephone_number": "812-582-7255",
            "fax_number": "812-975-7255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILIPPE BAUTISTA DMD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-26",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-06",
        "status": "A",
        "authorized_official_last_name": "BAUTISTA",
        "authorized_official_first_name": "PHILIPPE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "502-744-5442",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PBJ Kids Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PBJ Kids Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Personal Choice Inc
• Meagan Petersen, APRN
• Matthew David Peterson, M.D.
• Kelsey Petty
• Jamie Phelps
• Deborah R Phillips, LPN
• Sara Beth Phillips
• Gregory Ray Phipps
• Physician'S Care Group
• Physician'S Primary Care PLLC

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.