Provider Demographics
NPI:1982640751
Name:BATEMAN, BLAINE SMITH (DDS)
Entity Type:Individual
Prefix:DR
First Name:BLAINE
Middle Name:SMITH
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 1:218 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-1630
Mailing Address - Country:US
Mailing Address - Phone:801-756-9310
Mailing Address - Fax:801-763-8600
Practice Address - Street 1:218 N CENTER ST
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-1630
Practice Address - Country:US
Practice Address - Phone:801-756-9310
Practice Address - Fax:801-763-8600
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1355781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice