Healthcare Provider Details

I. General information

NPI: 1508106956
Provider Name (Legal Business Name): MARKUS GLEN BATEMAN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2013
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 41 BOX 5816
APO AE
09464-0059
US

IV. Provider business mailing address

PSC 41 BOX 5816
APO AE
09464-0059
US

V. Phone/Fax

Practice location:
  • Phone: 801-462-5476
  • Fax:
Mailing address:
  • Phone: 801-462-5476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8705423-9926
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number8705423-9926
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: