1992348866 NPI number — COLEMAN DENTAL ASSOCIATES CA, A DENTAL CORPORATION

Table of content: (NPI 1992348866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992348866 NPI number — COLEMAN DENTAL ASSOCIATES CA, A DENTAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLEMAN DENTAL ASSOCIATES CA, A DENTAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992348866
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7575 SAN FELIPE ST STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77063-1776
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-227-6453
Provider Business Mailing Address Fax Number:
855-827-7442

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2952 MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92102-3241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-798-4613
Provider Business Practice Location Address Fax Number:
619-798-4613
Provider Enumeration Date:
10/23/2019

Additional Information

Authorized Official

Authorized Official Last Name:
COLEMAN
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
HARVEY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
713-781-2800

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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