Provider Demographics
NPI:1831206119
Name:COLEMAN-BENNETT, MICHELE (DDS)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:COLEMAN-BENNETT
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 1:2053 MAYFLOWER DRIVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905
Mailing Address - Country:US
Mailing Address - Phone:202-607-1998
Mailing Address - Fax:
Practice Address - Street 1:2007 BUNKER HILL RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-3223
Practice Address - Country:US
Practice Address - Phone:202-635-7645
Practice Address - Fax:202-635-0032
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD9248122300000X
DCDEN47271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice