Provider Demographics
NPI:1790891760
Name:EARNEST D COALTER JR DDS PC
Entity Type:Organization
Organization Name:EARNEST D COALTER JR DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EARNEST
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:COALTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-491-8075
Mailing Address - Street 1:933 FIRST COLONIAL RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454
Mailing Address - Country:US
Mailing Address - Phone:757-491-8075
Mailing Address - Fax:757-422-4236
Practice Address - Street 1:933 FIRST COLONIAL RD
Practice Address - Street 2:SUITE 104
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454
Practice Address - Country:US
Practice Address - Phone:757-491-8075
Practice Address - Fax:757-422-4236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
003673OtherANTHEM INS