Provider Demographics
NPI:1699187427
Name:ARCHAMBAULT, COLE GARY (DMD)
Entity Type:Individual
Prefix:DR
First Name:COLE
Middle Name:GARY
Last Name:ARCHAMBAULT
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 1:1284 ELM ST
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-1827
Mailing Address - Country:US
Mailing Address - Phone:413-737-6387
Mailing Address - Fax:
Practice Address - Street 1:1284 ELM ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1827
Practice Address - Country:US
Practice Address - Phone:413-737-6387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18565381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice