Provider Demographics
NPI:1003141342
Name:COLEMAN, SHADONNA DANIELLE (DMD)
Entity Type:Individual
Prefix:
First Name:SHADONNA
Middle Name:DANIELLE
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 1:4655 MORSE CENTRE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-6601
Mailing Address - Country:US
Mailing Address - Phone:614-470-9840
Mailing Address - Fax:
Practice Address - Street 1:4655 MORSE CENTRE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-6601
Practice Address - Country:US
Practice Address - Phone:614-470-9840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300236231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice