Healthcare Provider Details

I. General information

NPI: 1275465379
Provider Name (Legal Business Name): BRYCE EMANUEL COLEMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 LINCOLN ST SW
CONCORD NC
28025-5469
US

IV. Provider business mailing address

5406 STRIVE ST APT 302
CHARLOTTE NC
28262-7024
US

V. Phone/Fax

Practice location:
  • Phone: 704-792-2313
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14716
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: