Provider Demographics
NPI:1861534851
Name:COLEMAN, ROBERT A (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
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 1:1955 MERRICK ROAD
Mailing Address - Street 2:SUITE101
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566
Mailing Address - Country:US
Mailing Address - Phone:516-378-0867
Mailing Address - Fax:516-378-0067
Practice Address - Street 1:1955 MERRICK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4642
Practice Address - Country:US
Practice Address - Phone:516-378-0867
Practice Address - Fax:516-378-0067
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice