Roderick L. Coleman, D.M.D., PA

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

315300 Issued in MS

Legal business name

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

Practice address

120 Holt Collier Dr
Suite D
Vicksburg, MS 39183-4408

Phone

(601) 619-4777

Fax

(601) 619-4667

NPI assigned

Dec 20, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Roderick L Coleman, D.M.D.NPI 1033249867

Title

Owner

Phone

(601) 619-4777

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Roderick L Coleman, D.M.D.

  • Pediatric Dentistry
  • Vicksburg, MS
  • NPI 1033249867
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1198108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198108800000",
    "number": "1962686394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 HOLT COLLIER DR",
            "address_2": "SUITE D",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391834408",
            "telephone_number": "601-619-4777",
            "fax_number": "601-619-4667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 HOLT COLLIER DR",
            "address_2": "SUITE D",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391834408",
            "telephone_number": "601-619-4777",
            "fax_number": "601-619-4667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RODERICK L. COLEMAN, D.M.D., PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-20",
        "last_updated": "2007-12-20",
        "status": "A",
        "authorized_official_last_name": "COLEMAN",
        "authorized_official_first_name": "RODERICK",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-619-4777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MS",
            "license": "315300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02988820",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Dentistry in Vicksburg, MS
• Providers in Vicksburg, MS by specialty
• Pediatric Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.