=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457560096
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PHILIP JOHN COLEMAN DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17203 SE 270TH PL
-----------------------------------------------------
City | COVINGTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98042-4941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-852-0480
-----------------------------------------------------
Fax | 253-854-8634
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13510 SE 250TH ST
-----------------------------------------------------
City | KENT
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98042-6635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-631-2635
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DE00003790
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DE00003790
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------