Provider Demographics
NPI:1659543148
Name:ROBERT L. COLES, DMD
Entity Type:Organization
Organization Name:ROBERT L. COLES, DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:COLES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-297-3601
Mailing Address - Street 1:15B WINCHESTER CT
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-2626
Mailing Address - Country:US
Mailing Address - Phone:864-297-3601
Mailing Address - Fax:
Practice Address - Street 1:15B WINCHESTER CT
Practice Address - Street 2:
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-2626
Practice Address - Country:US
Practice Address - Phone:864-297-3601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3803Medicare UPIN