MEDICARE: SHADONNA DANIELLE COLEMAN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	30023623	OH

General Provider Information

NPI Number	:	1003141342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHADONNA DANIELLE COLEMAN DMD

Provider Business Mailing Address
First Line	:	4655 MORSE CENTRE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-6601
Country	:	US
Telephone Number	:	614-470-9840
Fax Number	:

Provider Business Practice Location Address
First Line	:	4655 MORSE CENTRE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-6601
Country	:	US
Telephone Number	:	614-470-9840
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2009
Last Update Date	:	02/27/2024

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