Provider Demographics
NPI:1720008121
Name:COLEMAN, BRIAN OLIVER (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:OLIVER
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 ALOMA AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-7133
Mailing Address - Country:US
Mailing Address - Phone:407-671-1017
Mailing Address - Fax:407-678-1339
Practice Address - Street 1:7200 ALOMA AVE
Practice Address - Street 2:SUITE D
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-7133
Practice Address - Country:US
Practice Address - Phone:407-671-1017
Practice Address - Fax:407-678-1339
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL117871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice