Provider Demographics
NPI:1437116316
Name:COLEMAN, WALTER I (DDS)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:I
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 1:111 W DAYTON ST
Mailing Address - Street 2:PO BOX 138
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412-1112
Mailing Address - Country:US
Mailing Address - Phone:231-924-3600
Mailing Address - Fax:231-924-9720
Practice Address - Street 1:111 W DAYTON ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412
Practice Address - Country:US
Practice Address - Phone:231-924-3600
Practice Address - Fax:231-924-9720
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018831122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist