Coleman, Roderick L

Coleman, Roderick L is an sole proprietor health care provider with primary practice located at 120 Holt Collier Dr Suite D, Vicksburg MS 39183-4408. He recently has only one registered license in Dental Providers / Pediatric Dentistry, which is considered as his primary health care specialty. Coleman, Roderick L can be contacted via phone (601) 619-4777.

Contact Information

Primary practice address
120 Holt Collier Dr Suite D Vicksburg MS 39183-4408
Phone: (601) 619-4777
Fax: (601) 619-4667
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Pediatric Dentistry 1223P0221X 3153-00 Mississippi

Profile Details

NPI number 1033249867
LBN Legal business name Coleman, Roderick L
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 7th, 2007
Last updated Jul 9th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1033249867 NPPES
Mississippi MEDICAID 00660349
Mississippi MEDICAID 02988820

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