Provider Demographics
NPI:1508649344
Name:COLEMAN, COURTNEY MICHELLE (DDS)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MICHELLE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 1ST AVE S APT 401
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2546
Mailing Address - Country:US
Mailing Address - Phone:206-209-6350
Mailing Address - Fax:
Practice Address - Street 1:17126 REDMOND WAY
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4405
Practice Address - Country:US
Practice Address - Phone:425-224-8141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADENT.DE.61458660122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist