Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DS027567-L | PA |
NPI | 1003839564 |
---|---|
Provider Name | Dr. Brian Paul Coleman |
First Address | Gettysburg, PA 17325-1133 |
Second Address | Gettysburg, PA 17325-1133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 08/07/2007 |