Provider Demographics
NPI:1942686795
Name:BATEMAN, KELLIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:
Last Name:BATEMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 LITTLE RAVEN ST UNIT 1-204
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1456
Mailing Address - Country:US
Mailing Address - Phone:863-990-6881
Mailing Address - Fax:
Practice Address - Street 1:7025 SHERIDAN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80003-3814
Practice Address - Country:US
Practice Address - Phone:303-427-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00203045122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist