Provider Demographics
NPI:1497107742
Name:COLEMAN, JOSEPH DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DAVID
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 1:65-1158 MAMALAHOA HWY STE 27A
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8442
Mailing Address - Country:US
Mailing Address - Phone:808-885-7303
Mailing Address - Fax:808-885-7304
Practice Address - Street 1:65-1158 MAMALAHOA HWY STE 27A
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8442
Practice Address - Country:US
Practice Address - Phone:808-885-7303
Practice Address - Fax:808-885-7304
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT 2658122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist