Provider Demographics
NPI:1407442403
Name:CHOATE, COLEMAN RAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:COLEMAN
Middle Name:RAY
Last Name:CHOATE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4606 CEDAR SPRINGS RD APT 2025
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-7211
Mailing Address - Country:US
Mailing Address - Phone:618-318-0069
Mailing Address - Fax:
Practice Address - Street 1:4606 CEDAR SPRINGS RD APT 2025
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-7211
Practice Address - Country:US
Practice Address - Phone:618-318-0069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX369371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice