Provider Demographics
NPI:1750414181
Name:BATEMAN, RICHARD E (MAGD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:BATEMAN
Suffix:
Gender:M
Credentials:MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1567 N EASTMAN RD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-2683
Mailing Address - Country:US
Mailing Address - Phone:423-246-9231
Mailing Address - Fax:423-246-9232
Practice Address - Street 1:1567 N EASTMAN RD
Practice Address - Street 2:SUITE 16
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-2683
Practice Address - Country:US
Practice Address - Phone:423-246-9231
Practice Address - Fax:423-246-9232
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS38171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice