Provider Demographics
NPI:1285851121
Name:COLEMAN, ANGELA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10505 LIMA ROAD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818
Mailing Address - Country:US
Mailing Address - Phone:260-484-9248
Mailing Address - Fax:260-482-7217
Practice Address - Street 1:10505 LIMA ROAD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818
Practice Address - Country:US
Practice Address - Phone:260-484-9248
Practice Address - Fax:260-482-7217
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010281A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist