Provider Demographics
NPI:1801192158
Name:JOHN H. COLEMAN,PLLC
Entity Type:Organization
Organization Name:JOHN H. COLEMAN,PLLC
Other - Org Name:JOHN H. COLEMAN,PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:662-226-0585
Mailing Address - Street 1:1162 S LINE ST
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-4239
Mailing Address - Country:US
Mailing Address - Phone:662-226-0585
Mailing Address - Fax:662-226-0586
Practice Address - Street 1:1162 S LINE ST
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4239
Practice Address - Country:US
Practice Address - Phone:662-226-0585
Practice Address - Fax:662-226-0586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS196682122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty