Provider Demographics
NPI:1386651123
Name:DEMAS, COLEEN MARIE (ODS)
Entity Type:Individual
Prefix:DR
First Name:COLEEN
Middle Name:MARIE
Last Name:DEMAS
Suffix:
Gender:F
Credentials:ODS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4174 WHEATLEY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:RICHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44286-9052
Mailing Address - Country:US
Mailing Address - Phone:330-659-0201
Mailing Address - Fax:330-659-0334
Practice Address - Street 1:4174 WHEATLEY RD
Practice Address - Street 2:SUITE 400
Practice Address - City:RICHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44286-9052
Practice Address - Country:US
Practice Address - Phone:330-659-0201
Practice Address - Fax:330-659-0334
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-213351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice