Provider Demographics
NPI:1376680504
Name:COLEMAN, RODNEY DEAN (DMD)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:DEAN
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 LEXINGTON ROAD
Mailing Address - Street 2:SUITE J
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475
Mailing Address - Country:US
Mailing Address - Phone:859-625-5522
Mailing Address - Fax:859-625-9352
Practice Address - Street 1:2130 LEXINGTON ROAD
Practice Address - Street 2:SUITE J
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475
Practice Address - Country:US
Practice Address - Phone:859-625-5522
Practice Address - Fax:859-625-9352
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY72661223G0001X
KY72661223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60072667Medicaid