Provider Demographics
NPI:1447433982
Name:BATEMAN, KENNETH HOWARD (DDS)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:HOWARD
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:PO BOX 8426
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76124-0426
Mailing Address - Country:US
Mailing Address - Phone:817-691-8649
Mailing Address - Fax:
Practice Address - Street 1:216 GREEN RIVER TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103-1038
Practice Address - Country:US
Practice Address - Phone:817-691-8649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11052122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist