Healthcare Provider Details

I. General information

NPI: 1184233702
Provider Name (Legal Business Name): AMELIA BETH COLEMAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16005 US-23 SOUTH
CATLETTSBURG KY
41129
US

IV. Provider business mailing address

16005 US-23 SOUTH
CATLETTSBURG KY
41129
US

V. Phone/Fax

Practice location:
  • Phone: 606-739-0403
  • Fax: 606-739-0405
Mailing address:
  • Phone: 606-739-0403
  • Fax: 606-739-0405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10497
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: