Healthcare Provider Details

I. General information

NPI: 1003141342
Provider Name (Legal Business Name): SHADONNA DANIELLE COLEMAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2009
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4655 MORSE CENTRE RD
COLUMBUS OH
43229-6601
US

IV. Provider business mailing address

4655 MORSE CENTRE RD
COLUMBUS OH
43229-6601
US

V. Phone/Fax

Practice location:
  • Phone: 614-470-9840
  • Fax:
Mailing address:
  • Phone: 614-470-9840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30023623
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: