MEDICARE: DR. JEFFREY MICHAEL COLEMAN DDS

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	122300000X	Dentist	60644	CA

General Provider Information

NPI Number	:	1033497730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY MICHAEL COLEMAN DDS

Provider Business Mailing Address
First Line	:	19711 SEASHORE CIR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-3037
Country	:	US
Telephone Number	:	714-878-0405
Fax Number	:

Provider Business Practice Location Address
First Line	:	6968 WARNER AVE
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-5316
Country	:	US
Telephone Number	:	714-842-5593
Fax Number	:

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

Provider Enumeration Date	:	07/28/2011
Last Update Date	:	07/28/2011

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