Provider Demographics
NPI:1790417905
Name:JEFFREY M. COLEMAN, D.D.S., INC.
Entity Type:Organization
Organization Name:JEFFREY M. COLEMAN, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-847-7733
Mailing Address - Street 1:18800 MAIN ST STE 210
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1718
Mailing Address - Country:US
Mailing Address - Phone:714-847-7733
Mailing Address - Fax:714-842-3072
Practice Address - Street 1:18800 MAIN ST STE 210
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1718
Practice Address - Country:US
Practice Address - Phone:714-847-7733
Practice Address - Fax:714-842-3072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental