Provider Demographics
NPI:1881614220
Name:BATEMAN, DOUGLAS CRAIG (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:CRAIG
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 1:52592 WILLOW BEND DR
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-7466
Mailing Address - Country:US
Mailing Address - Phone:574-272-3198
Mailing Address - Fax:574-272-3198
Practice Address - Street 1:52592 WILLOW BEND DR
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-7466
Practice Address - Country:US
Practice Address - Phone:574-272-3198
Practice Address - Fax:574-272-3198
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12006916A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice