Organization
BRADLEY WAYNE COLEMAN,D.D.S.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLEY WAYNE COLEMAN D.D.S. (PRESIDENT)
(870) 424-4670
Entity
Organization
Contact information
Practice address
330 HIGHWAY 5 NORTH, SUITE #10, MOUNTAIN HOME, AR 72653
(870) 424-4670
(870) 425-4674
Mailing address
330 HIGHWAY 5 NORTH, SUITE #10, MOUNTAIN HOME, AR 72653
(870) 424-4670
(870) 425-4674
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3663
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
168221608
—
AR
Enumeration date
06/09/2008
Last updated
08/31/2016
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