Provider Demographics
NPI:1649474958
Name:BLAIR A BATEMAN DDS PC FAMILY DENTISTRY
Entity type:Organization
Organization Name:BLAIR A BATEMAN DDS PC FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAIR
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:BATEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-773-3777
Mailing Address - Street 1:2179 WEST 1800 NORTH
Mailing Address - Street 2:#A
Mailing Address - City:CLINTON
Mailing Address - State:UT
Mailing Address - Zip Code:84015
Mailing Address - Country:US
Mailing Address - Phone:801-773-3777
Mailing Address - Fax:
Practice Address - Street 1:2179 WEST 1800 NORTH
Practice Address - Street 2:#A
Practice Address - City:CLINTON
Practice Address - State:UT
Practice Address - Zip Code:84015
Practice Address - Country:US
Practice Address - Phone:801-773-3777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8814389499211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty