Provider Demographics
NPI:1558665174
Name:COOLE, JOHN R (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:COOLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16933-1432
Mailing Address - Country:US
Mailing Address - Phone:570-662-2886
Mailing Address - Fax:570-513-0585
Practice Address - Street 1:17 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:PA
Practice Address - Zip Code:16933-1432
Practice Address - Country:US
Practice Address - Phone:570-662-2886
Practice Address - Fax:570-513-0585
Is Sole Proprietor?:No
Enumeration Date:2010-12-23
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030574L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist