Individual
BRACKEN ROSS BATEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
242 E MAIN ST, REXBURG, ID 83440-2022
(208) 680-7067
Mailing address
4461 DELOY DR, IDAHO FALLS, ID 83401-1226
(208) 680-7067
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-5151
ID
Other
Enumeration date
06/03/2020
Last updated
06/03/2020
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