MEDICARE: COLEMAN DENTAL ASSOCIATES, 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	1223P0221X	Pediatric Dentistry	DN013127	GA
2	1223G0001X	General Practice Dentistry	DN010307	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710131545
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLEMAN DENTAL ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	970 MARTIN LUTHER KING JR DR SW
Second Line	:	SUITE 301
City	:	ATLANTA
State	:	GA
Zip	:	30314-2962
Country	:	US
Telephone Number	:	404-523-3153
Fax Number	:	404-523-0136

Provider Business Practice Location Address
First Line	:	970 MARTIN LUTHER KING JR DR SW
Second Line	:	SUITE 301
City	:	ATLANTA
State	:	GA
Zip	:	30314-2962
Country	:	US
Telephone Number	:	404-523-3153
Fax Number	:	404-523-0136

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARLA O. COLEMAN
Credential	:	DDS
Telephone Number	:	404-523-3153

Provider Enumeration Date	:	11/06/2008
Last Update Date	:	11/06/2008

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Directions to “COLEMAN DENTAL ASSOCIATES, PC ” Practice Location

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