Provider Demographics
NPI:1003826751
Name:BATEMAN, ADAM RHEES (DDS, MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:RHEES
Last Name:BATEMAN
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2961 W MAPLE LOOP DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-5686
Mailing Address - Country:US
Mailing Address - Phone:801-653-2929
Mailing Address - Fax:
Practice Address - Street 1:2961 W MAPLE LOOP DR
Practice Address - Street 2:SUITE 130
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-5686
Practice Address - Country:US
Practice Address - Phone:801-653-2929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4752843-99241223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
20-5015595OtherTIN