Provider Demographics
NPI:1740467786
Name:COLEMAN, M. SCOTT (DMD)
Entity type:Individual
Prefix:DR
First Name:M.
Middle Name:SCOTT
Last Name:COLEMAN
Suffix:
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 1:160 N SECTION ST
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-2440
Mailing Address - Country:US
Mailing Address - Phone:251-928-8381
Mailing Address - Fax:251-928-8365
Practice Address - Street 1:160 N SECTION ST
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2440
Practice Address - Country:US
Practice Address - Phone:251-928-8381
Practice Address - Fax:251-928-8365
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL49101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALAL1240Medicare UPIN