MEDICARE: MR. BRAD LAMONT BATEMAN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D6913	OR
2	122300000X	Dentist	39599	CA

General Provider Information

NPI Number	:	1578557823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRAD LAMONT BATEMAN DMD

Provider Business Mailing Address
First Line	:	1005 13TH ST SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-2506
Country	:	US
Telephone Number	:	503-364-7232
Fax Number	:	503-364-9187

Provider Business Practice Location Address
First Line	:	1005 13TH ST SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-2506
Country	:	US
Telephone Number	:	503-364-7232
Fax Number	:	503-364-9187

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	07/08/2007

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