Provider Demographics
NPI:1821120882
Name:BRAMLETT, COLEMAN LYNWOOD JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:COLEMAN
Middle Name:LYNWOOD
Last Name:BRAMLETT
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 484
Mailing Address - Street 2:
Mailing Address - City:BISHOPVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29010-0484
Mailing Address - Country:US
Mailing Address - Phone:803-484-6096
Mailing Address - Fax:803-484-4380
Practice Address - Street 1:734 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:BISHOPVILLE
Practice Address - State:SC
Practice Address - Zip Code:29010-1016
Practice Address - Country:US
Practice Address - Phone:803-484-6096
Practice Address - Fax:803-484-4380
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice