Provider Demographics
NPI:1043545627
Name:MATTHEW D. COLE, DDS, PC
Entity Type:Organization
Organization Name:MATTHEW D. COLE, DDS, PC
Other - Org Name:1ST IMPRESSIONS DENTISTRY OF YUKON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:D
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-354-4806
Mailing Address - Street 1:1401 S RANCHWOOD BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-2760
Mailing Address - Country:US
Mailing Address - Phone:405-354-4806
Mailing Address - Fax:405-354-1277
Practice Address - Street 1:1401 S. RANCHWOOD BLVD., STE. 110
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-7309
Practice Address - Country:US
Practice Address - Phone:405-354-4806
Practice Address - Fax:405-354-1277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK60611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty