Provider Demographics
NPI:1730296781
Name:COLEMAN, NORMAN KENNEY (DDS)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:KENNEY
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 1:8150 LEESBURG PIKE STE 920
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2714
Mailing Address - Country:US
Mailing Address - Phone:915-217-7723
Mailing Address - Fax:703-821-0692
Practice Address - Street 1:8150 LEESBURG PIKE STE 920
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2714
Practice Address - Country:US
Practice Address - Phone:915-217-7723
Practice Address - Fax:703-821-0692
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA034661223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC179458Medicare PIN