Provider Demographics
NPI:1669014379
Name:ANDREW M. BATEMAN DMD, PLLC
Entity Type:Organization
Organization Name:ANDREW M. BATEMAN DMD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:BATEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-766-4042
Mailing Address - Street 1:2961 W MAPLE LOOP DR STE 110
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-5717
Mailing Address - Country:US
Mailing Address - Phone:801-766-4042
Mailing Address - Fax:
Practice Address - Street 1:2961 W MAPLE LOOP DR STE 110
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-5717
Practice Address - Country:US
Practice Address - Phone:801-766-4042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental