Healthcare Provider Details

I. General information

NPI: 1184111445
Provider Name (Legal Business Name): RILEY ALSTON BATEMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2018
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 SAN MATEO RD STE 104
HALF MOON BAY CA
94019-7172
US

IV. Provider business mailing address

300 CENTRAL AVE
HALF MOON BAY CA
94019-1847
US

V. Phone/Fax

Practice location:
  • Phone: 650-726-2144
  • Fax:
Mailing address:
  • Phone: 650-339-2875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number104175
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: