Provider Demographics
NPI:1255545828
Name:COLEMAN, JANET LYNN (RDA)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:LYNN
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 CHERRYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37912-1107
Mailing Address - Country:US
Mailing Address - Phone:865-947-5164
Mailing Address - Fax:865-691-4291
Practice Address - Street 1:323 FOX RD
Practice Address - Street 2:SUITE 200
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3383
Practice Address - Country:US
Practice Address - Phone:865-690-5231
Practice Address - Fax:865-691-4291
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4168126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant