Provider Demographics
NPI:1184111445
Name:BATEMAN, RILEY ALSTON (DDS)
Entity type:Individual
Prefix:DR
First Name:RILEY
Middle Name:ALSTON
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 1:300 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-1847
Mailing Address - Country:US
Mailing Address - Phone:650-339-2875
Mailing Address - Fax:
Practice Address - Street 1:210 SAN MATEO RD STE 104
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-7172
Practice Address - Country:US
Practice Address - Phone:650-726-2144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA104175122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program