Provider Demographics
NPI:1356467468
Name:COLE, MICHEAL ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHEAL
Middle Name:ANTHONY
Last Name:COLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6500 S FLORES ST
Mailing Address - Street 2:#102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78214-2628
Mailing Address - Country:US
Mailing Address - Phone:210-924-5933
Mailing Address - Fax:210-924-5934
Practice Address - Street 1:6500 S FLORES ST
Practice Address - Street 2:#102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78214-2628
Practice Address - Country:US
Practice Address - Phone:210-924-5933
Practice Address - Fax:210-924-5934
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice