Individual
TRAVIS K COLEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1001 CUMBERLAND FALLS HWY, CORBIN, KY 40701
(337) 277-8502
Mailing address
190 CLARENCE CORMIER RD, CARENCRO, LA 70520-5719
(337) 277-8502
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10255
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/12/2019
Last updated
05/28/2019
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