Provider Demographics
NPI:1124423959
Name:BATEMAN ETMAN, KAYLA (DDS)
Entity type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:
Last Name:BATEMAN ETMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:BATEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2151 VILLAGE WALK DR APT 17305
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-5758
Mailing Address - Country:US
Mailing Address - Phone:412-952-3191
Mailing Address - Fax:
Practice Address - Street 1:4 SUNSET WAY
Practice Address - Street 2:BLDG C
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014
Practice Address - Country:US
Practice Address - Phone:702-968-5222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-22
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS3-3091223X0400X
NV6550122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist