Provider Demographics
NPI:1578949541
Name:DOLE, COLIN ALFRED (DMD)
Entity Type:Individual
Prefix:DR
First Name:COLIN
Middle Name:ALFRED
Last Name:DOLE
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 1:1725 SW FOREST RIDGE AVE
Mailing Address - Street 2:APT D
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1925
Mailing Address - Country:US
Mailing Address - Phone:208-790-0454
Mailing Address - Fax:
Practice Address - Street 1:1201 NW WALL ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-1956
Practice Address - Country:US
Practice Address - Phone:458-206-0953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD10328122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist