Provider Demographics
NPI:1235247438
Name:COLEMAN, BRETT R (DMD MS)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:R
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 S 2000 W
Mailing Address - Street 2:BLDG E304
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075
Mailing Address - Country:US
Mailing Address - Phone:801-614-9091
Mailing Address - Fax:801-614-9091
Practice Address - Street 1:780 S 2000 W
Practice Address - Street 2:BLDG E304
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075
Practice Address - Country:US
Practice Address - Phone:801-614-9090
Practice Address - Fax:801-614-9091
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT512585799211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics