Provider Demographics
NPI:1629561253
Name:MCCLOSKEY, COLE P (DDS)
Entity Type:Individual
Prefix:DR
First Name:COLE
Middle Name:P
Last Name:MCCLOSKEY
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 1:9261 SAINT CLAIR HWY
Mailing Address - Street 2:
Mailing Address - City:CASCO
Mailing Address - State:MI
Mailing Address - Zip Code:48064-1224
Mailing Address - Country:US
Mailing Address - Phone:586-531-6844
Mailing Address - Fax:
Practice Address - Street 1:36600 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MI
Practice Address - Zip Code:48062-1937
Practice Address - Country:US
Practice Address - Phone:586-727-3815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010226791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty