Provider Demographics
NPI:1386833325
Name:DRS. COLEMAN AND TAYLOR, D.D.S., M.S.
Entity Type:Organization
Organization Name:DRS. COLEMAN AND TAYLOR, D.D.S., M.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-638-8230
Mailing Address - Street 1:2356 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39183-2857
Mailing Address - Country:US
Mailing Address - Phone:601-638-2360
Mailing Address - Fax:601-636-3388
Practice Address - Street 1:2356 GROVE ST
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39183-2857
Practice Address - Country:US
Practice Address - Phone:601-638-2360
Practice Address - Fax:601-636-3388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty