Provider Demographics
NPI:1033529391
Name:COLE, ADEMOLA O (DDS)
Entity Type:Individual
Prefix:
First Name:ADEMOLA
Middle Name:O
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 1:625 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-2913
Mailing Address - Country:US
Mailing Address - Phone:585-275-5087
Mailing Address - Fax:585-273-1235
Practice Address - Street 1:3486 C EMMORTON ROAD
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009
Practice Address - Country:US
Practice Address - Phone:410-200-9081
Practice Address - Fax:585-273-1235
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD160031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice