Provider Demographics
NPI:1851884258
Name:BATEMAN, HEATH TRIPP (DDS)
Entity Type:Individual
Prefix:
First Name:HEATH
Middle Name:TRIPP
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 1:2105 W 3600 S
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:ID
Mailing Address - Zip Code:83286-5162
Mailing Address - Country:US
Mailing Address - Phone:801-851-0121
Mailing Address - Fax:
Practice Address - Street 1:395 E 600 S
Practice Address - Street 2:
Practice Address - City:PRESTON
Practice Address - State:ID
Practice Address - Zip Code:83263-4901
Practice Address - Country:US
Practice Address - Phone:208-852-0194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10858697-99221223G0001X
IDD-53581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice