Provider Demographics
NPI:1710015474
Name:KELLENE M. COLE DDS A.P.D.C.
Entity Type:Organization
Organization Name:KELLENE M. COLE DDS A.P.D.C.
Other - Org Name:JACKSON AND COLE D.D.S.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RICHELLE
Authorized Official - Middle Name:K
Authorized Official - Last Name:PUNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-738-1567
Mailing Address - Street 1:9541 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:RIVER RIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70123
Mailing Address - Country:US
Mailing Address - Phone:504-738-1567
Mailing Address - Fax:504-738-1571
Practice Address - Street 1:9541 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:RIVER RIDGE
Practice Address - State:LA
Practice Address - Zip Code:70123
Practice Address - Country:US
Practice Address - Phone:504-738-1567
Practice Address - Fax:504-738-1571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA26343Medicaid