Provider Demographics
NPI:1528627270
Name:COLEMAN, ALEXANDRA LEIGH (DMD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:LEIGH
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4030 TATES CREEK RD APT 5403
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-3189
Mailing Address - Country:US
Mailing Address - Phone:678-559-7622
Mailing Address - Fax:
Practice Address - Street 1:2358 NICHOLASVILLE RD STE 155
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3041
Practice Address - Country:US
Practice Address - Phone:859-381-0680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10283122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist