Provider Demographics
NPI:1609961911
Name:COLEMAN, PAUL HOWARD JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:HOWARD
Last Name:COLEMAN
Suffix:JR
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 1:12324 OAK KNOLL RD
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-5320
Mailing Address - Country:US
Mailing Address - Phone:858-748-4802
Mailing Address - Fax:858-478-7941
Practice Address - Street 1:12324 OAK KNOLL RD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-5320
Practice Address - Country:US
Practice Address - Phone:858-748-4802
Practice Address - Fax:858-478-7941
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice