Provider Demographics
NPI:1124132501
Name:COLEMAN, GARY RUBE (DMD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:RUBE
Last Name:COLEMAN
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 1:3008 MERIDETH CIR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1725
Mailing Address - Country:US
Mailing Address - Phone:859-223-8299
Mailing Address - Fax:
Practice Address - Street 1:3708 WILLOW RIDGE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40514-1562
Practice Address - Country:US
Practice Address - Phone:859-296-9252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY51471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice