Provider Demographics
NPI:1093803223
Name:COLE, RANDALL J (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:J
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 1:5474 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32571-1575
Mailing Address - Country:US
Mailing Address - Phone:850-994-4281
Mailing Address - Fax:850-994-5166
Practice Address - Street 1:5474 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32571-1575
Practice Address - Country:US
Practice Address - Phone:850-994-4281
Practice Address - Fax:850-994-5166
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN012235122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist