Organization
CEMENTUM LLC
Active
Other names
Bateman Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLY ANN BATEMAN DMD (OWNER/DENTIST)
(936) 205-1706
Entity
Organization
Contact information
Practice address
4704 NE STALLINGS DR, NACOGDOCHES, TX 75965-1615
(936) 205-1706
Mailing address
4704 NE STALLINGS DR, NACOGDOCHES, TX 75965-1615
(936) 205-1706
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801104427
—
TX
Enumeration date
04/08/2021
Last updated
05/27/2025
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