Provider Demographics
NPI:1841604055
Name:BATEMAN, JACOB RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:RICHARD
Last Name:BATEMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1567 N EASTMAN RD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-2683
Mailing Address - Country:US
Mailing Address - Phone:423-247-9231
Mailing Address - Fax:423-246-9299
Practice Address - Street 1:1567 N EASTMAN RD
Practice Address - Street 2:SUITE 16
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-2683
Practice Address - Country:US
Practice Address - Phone:423-247-9231
Practice Address - Fax:423-246-9299
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9863122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist