Provider Demographics
NPI:1437242195
Name:COLEMAN, ALAN WESLEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:WESLEY
Last Name:COLEMAN
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:PO BOX 949
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35612
Mailing Address - Country:US
Mailing Address - Phone:256-232-0789
Mailing Address - Fax:256-232-5247
Practice Address - Street 1:110 COLLEGE ST
Practice Address - Street 2:SUITE D
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611
Practice Address - Country:US
Practice Address - Phone:256-232-0789
Practice Address - Fax:256-232-5247
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL38361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice