Healthcare Provider Details

I. General information

NPI: 1891723904
Provider Name (Legal Business Name): ALLYN J COLEMAN DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 07/13/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ALEXANDRIA VA HEALTH CARE SYSTEM 2495 SHREVEPORT HIGHWAY
PINEVILLE LA
71360-4044
US

IV. Provider business mailing address

1354 S 117TH ST
WEST ALLIS WI
53214-2127
US

V. Phone/Fax

Practice location:
  • Phone: 318-473-0010
  • Fax:
Mailing address:
  • Phone: 414-258-0281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number046124
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: