Organization
RODERICK L. COLEMAN, D.M.D., PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RODERICK L COLEMAN D.M.D. (OWNER)
(601) 619-4777
Entity
Organization
Contact information
Practice address
120 HOLT COLLIER DR, SUITE D, VICKSBURG, MS 39183-4408
(601) 619-4777
(601) 619-4667
Mailing address
120 HOLT COLLIER DR, SUITE D, VICKSBURG, MS 39183-4408
(601) 619-4777
(601) 619-4667
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
315300
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02988820
—
MS
Enumeration date
12/20/2007
Last updated
12/20/2007
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