Provider Demographics
NPI:1922538107
Name:COLEMAN, CHRISTINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 EDDY ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4923
Mailing Address - Country:US
Mailing Address - Phone:401-444-7195
Mailing Address - Fax:401-444-4098
Practice Address - Street 1:7611 S OSBORNE RD
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-4200
Practice Address - Country:US
Practice Address - Phone:301-780-7602
Practice Address - Fax:301-780-7602
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILD00132122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist