Provider Demographics
NPI:1033296009
Name:COLES, JULIUS N
Entity Type:Individual
Prefix:
First Name:JULIUS
Middle Name:N
Last Name:COLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JULIUS
Other - Middle Name:N
Other - Last Name:COLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:63 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4042
Mailing Address - Country:US
Mailing Address - Phone:508-559-6699
Mailing Address - Fax:508-559-1158
Practice Address - Street 1:63 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4042
Practice Address - Country:US
Practice Address - Phone:508-584-2708
Practice Address - Fax:508-559-1158
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1210420122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX3007Medicare PIN
MAT57780Medicare UPIN