Provider Demographics
NPI:1558748426
Name:COLEMAN, DAVID JAMES (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JAMES
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 1:235 PAVONIA AVE UNIT 763
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-1777
Mailing Address - Country:US
Mailing Address - Phone:917-574-4914
Mailing Address - Fax:
Practice Address - Street 1:375 S END AVE OFC B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10280-1014
Practice Address - Country:US
Practice Address - Phone:917-574-4914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040565122300000X
NY0602541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist