Provider Demographics
NPI:1023185485
Name:COLE, REGINALD WAYNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:WAYNE
Last Name:COLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 EAST WEST HIGHWAY SUITE F
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814
Mailing Address - Country:US
Mailing Address - Phone:301-718-3656
Mailing Address - Fax:301-718-0836
Practice Address - Street 1:4400 EAST WEST HIGHWAY SUITE F
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814
Practice Address - Country:US
Practice Address - Phone:301-718-3656
Practice Address - Fax:301-718-0836
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD093141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice