Provider Demographics
NPI:1619262722
Name:COLEY, ADAM MICHAEL (DDS)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:MICHAEL
Last Name:COLEY
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 1:3004 COGGIN AVE
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-6005
Mailing Address - Country:US
Mailing Address - Phone:325-646-3755
Mailing Address - Fax:
Practice Address - Street 1:3004 COGGIN AVE
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-6005
Practice Address - Country:US
Practice Address - Phone:325-646-3755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27032122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist