Doctor Name: | RODERICK L COLEMAN |
NPI Number: | 1033249867 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.M.D. |
License Number: | 3153-00 |
Business Practice Address: | 120 Holt Collier Dr Suite D Vicksburg, MS - 391834408 |
Business Phone Number: | 6016194777 |
Business Fax Number: | 6016194667 |
Mailing Address: | 120 Holt Collier Dr, Suite D VICKSBURG |
State: | MS |
Postal Code: | 391834408 |
Phone Number: | 6016194777 |
Fax Number: | 6016194667 |
NPI Enumeration Date: | 03/07/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1223P0221X |
License Number: | 3153-00 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Dentist |
Taxonomy Specialization: | Pediatric Dentistry |
Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |