Provider Demographics
NPI:1801388368
Name:COLEMAN, ALINA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALINA
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ALINA
Other - Middle Name:
Other - Last Name:LENZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:279 CREEKMORE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3251
Mailing Address - Country:US
Mailing Address - Phone:786-202-9024
Mailing Address - Fax:
Practice Address - Street 1:4689 US HIGHWAY 17 STE 6
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4831
Practice Address - Country:US
Practice Address - Phone:904-278-7567
Practice Address - Fax:904-278-7632
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23376122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist