Healthcare Provider Details

I. General information

NPI: 1235247438
Provider Name (Legal Business Name): BRETT R COLEMAN DMD MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 S 2000 W BLDG E304
SYRACUSE UT
84075
US

IV. Provider business mailing address

780 S 2000 W BLDG E304
SYRACUSE UT
84075
US

V. Phone/Fax

Practice location:
  • Phone: 801-614-9090
  • Fax: 801-614-9091
Mailing address:
  • Phone: 801-614-9091
  • Fax: 801-614-9091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number51258579921
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: