Provider Demographics
NPI:1063792422
Name:DOW, COLEMAN ALEXANDER (DMD)
Entity type:Individual
Prefix:DR
First Name:COLEMAN
Middle Name:ALEXANDER
Last Name:DOW
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 18TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-3425
Mailing Address - Country:US
Mailing Address - Phone:541-726-9644
Mailing Address - Fax:
Practice Address - Street 1:1455 18TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-3425
Practice Address - Country:US
Practice Address - Phone:541-726-9644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9636122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist