MEDICARE: DR. JONATHAN F COLEMAN DDS, PC

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	264646	UT

General Provider Information

NPI Number	:	1609875715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN F COLEMAN DDS, PC

Provider Business Mailing Address
First Line	:	1441 UTE BLVD
Second Line	:	SUITE 200
City	:	PARK CITY
State	:	UT
Zip	:	84098-7630
Country	:	US
Telephone Number	:	435-604-0887
Fax Number	:	435-604-0885

Provider Business Practice Location Address
First Line	:	1441 UTE BLVD.
Second Line	:	SUITE 200
City	:	PARK CITY
State	:	UT
Zip	:	84098
Country	:	US
Telephone Number	:	435-604-0887
Fax Number	:	435-604-0885

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	09/05/2008

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