Provider Demographics
NPI:1811001647
Name:COLE, JONATHAN KING (DMD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:KING
Last Name:COLE
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 1:318 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2342
Mailing Address - Country:US
Mailing Address - Phone:814-375-8990
Mailing Address - Fax:814-371-0290
Practice Address - Street 1:190 W PARK AVE STE 4
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2277
Practice Address - Country:US
Practice Address - Phone:814-375-7515
Practice Address - Fax:814-375-1270
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024511L1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA112780OtherINSURANCE PROVIDER ID