# RODERICK L. COLEMAN, D.M.D., PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962686394
- **Authorized official:** DR. RODERICK L COLEMAN D.M.D. (OWNER)
- **Authorized official phone:** (601) 619-4777

## Contact information

- **Practice address:** 120 HOLT COLLIER DR, SUITE D, VICKSBURG, MS 39183-4408
- **Practice address phone:** (601) 619-4777
- **Practice address fax:** (601) 619-4667
- **Mailing address:** 120 HOLT COLLIER DR, SUITE D, VICKSBURG, MS 39183-4408
- **Mailing address phone:** (601) 619-4777
- **Mailing address fax:** (601) 619-4667

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 315300 | MS | Yes |

## Other

- **Enumeration date:** 12/20/2007
- **Last updated:** 12/20/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 02988820 | — | MS |