Provider Demographics
NPI:1659430148
Name:COLE, BARRY S
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:S
Last Name:COLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 HIGHWAY 287 N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-8824
Mailing Address - Country:US
Mailing Address - Phone:817-473-3010
Mailing Address - Fax:817-473-1888
Practice Address - Street 1:1560 HIGHWAY 287 N
Practice Address - Street 2:SUITE 100
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8824
Practice Address - Country:US
Practice Address - Phone:817-473-3010
Practice Address - Fax:817-473-1888
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX166891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice