Provider Demographics
NPI:1306232327
Name:COLEMAN, TARAH (DDS)
Entity type:Individual
Prefix:DR
First Name:TARAH
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3090 E HIGHWAY 27 STE A
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-9408
Mailing Address - Country:US
Mailing Address - Phone:704-732-2629
Mailing Address - Fax:
Practice Address - Street 1:3090 E HIGHWAY 27 STE A
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-9408
Practice Address - Country:US
Practice Address - Phone:704-732-2629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC99891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program