Healthcare Provider Details

I. General information

NPI: 1497837967
Provider Name (Legal Business Name): BOBBI D. COLEMAN D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 NORTH LEVISA ROAD
MOUTHCARD KY
41548
US

IV. Provider business mailing address

PO BOX 150
MOUTHCARD KY
41548-0150
US

V. Phone/Fax

Practice location:
  • Phone: 606-835-2167
  • Fax: 606-835-0541
Mailing address:
  • Phone: 606-835-2167
  • Fax: 606-835-0541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6614
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: