Provider Demographics
NPI:1194817262
Name:COLEMAN, JOHN S (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:S
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 1:3011 S LINDSAY RD
Mailing Address - Street 2:#104
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-0701
Mailing Address - Country:US
Mailing Address - Phone:480-855-5544
Mailing Address - Fax:480-855-7889
Practice Address - Street 1:3011 S LINDSAY RD
Practice Address - Street 2:#104
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-0701
Practice Address - Country:US
Practice Address - Phone:480-855-5544
Practice Address - Fax:480-855-7889
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ56461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice