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NPI Code Detail

MEDICARE: MR. BRAD LAMONT BATEMAN DMD

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
1122300000XDentistD6913OR
2122300000XDentist39599CA

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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