MEDICARE: DR. ANGELA COLEMAN D.D.S.

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	20168	TX
2	1223G0001X	General Practice Dentistry	6673	OK

General Provider Information

NPI Number	:	1518055425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA COLEMAN D.D.S.

Provider Business Mailing Address
First Line	:	3000 N GRAND BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-1818
Country	:	US
Telephone Number	:	405-632-6688
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 N GRAND BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-1818
Country	:	US
Telephone Number	:	405-632-6688
Fax Number	:

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/20/2021

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