Provider Demographics
NPI:1497837967
Name:COLEMAN, BOBBI D (DMD)
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:D
Last Name:COLEMAN
Suffix:
Gender:F
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 150
Mailing Address - Street 2:
Mailing Address - City:MOUTHCARD
Mailing Address - State:KY
Mailing Address - Zip Code:41548-0150
Mailing Address - Country:US
Mailing Address - Phone:606-835-2167
Mailing Address - Fax:606-835-0541
Practice Address - Street 1:184 NORTH LEVISA ROAD
Practice Address - Street 2:
Practice Address - City:MOUTHCARD
Practice Address - State:KY
Practice Address - Zip Code:41548
Practice Address - Country:US
Practice Address - Phone:606-835-2167
Practice Address - Fax:606-835-0541
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY66141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice