Healthcare Provider Details

I. General information

NPI: 1144936378
Provider Name (Legal Business Name): BRITTINI COLEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 01/31/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 777 UNIT 2060 HEADQUARTERS RD
APO AP
96278-2060
US

IV. Provider business mailing address

PSC 3 BOX 9374
APO AP
96266-0094
US

V. Phone/Fax

Practice location:
  • Phone: 315-784-2459
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: