Provider Demographics
NPI:1992348866
Name:COLEMAN DENTAL ASSOCIATES CA, A DENTAL CORPORATION
Entity type:Organization
Organization Name:COLEMAN DENTAL ASSOCIATES CA, A DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:HARVEY
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-781-2800
Mailing Address - Street 1:7575 SAN FELIPE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-1776
Mailing Address - Country:US
Mailing Address - Phone:713-227-6453
Mailing Address - Fax:855-827-7442
Practice Address - Street 1:2952 MARKET ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-3241
Practice Address - Country:US
Practice Address - Phone:619-798-4613
Practice Address - Fax:619-798-4613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-23
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty