Provider Demographics
NPI:1922023100
Name:BATEMAN, LARRY R (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:R
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 1:10009 PARK CEDAR DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8903
Mailing Address - Country:US
Mailing Address - Phone:704-541-5059
Mailing Address - Fax:
Practice Address - Street 1:10009 PARK CEDAR DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8903
Practice Address - Country:US
Practice Address - Phone:704-541-5059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5262122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist