Provider Demographics
NPI:1831882612
Name:COLEMAN, MICAH (DDS)
Entity type:Individual
Prefix:DR
First Name:MICAH
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11877 NE TONY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:OK
Mailing Address - Zip Code:73538-2046
Mailing Address - Country:US
Mailing Address - Phone:580-704-8042
Mailing Address - Fax:
Practice Address - Street 1:2111 NW CACHE RD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5213
Practice Address - Country:US
Practice Address - Phone:580-699-8802
Practice Address - Fax:580-699-8803
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK76961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice