Provider Demographics
NPI:1306197884
Name:COLEMAN, BURTON A (DDS)
Entity Type:Individual
Prefix:DR
First Name:BURTON
Middle Name:A
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 RUDOLPHTOWN RD
Mailing Address - Street 2:STE B
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-2228
Mailing Address - Country:US
Mailing Address - Phone:931-259-4400
Mailing Address - Fax:931-259-4401
Practice Address - Street 1:2309 RUDOLPHTOWN RD
Practice Address - Street 2:STE B
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-2228
Practice Address - Country:US
Practice Address - Phone:931-259-4400
Practice Address - Fax:931-259-4401
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-25
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9567122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist