Provider Demographics
NPI:1962672287
Name:COLE, JESSE LANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:LANE
Last Name:COLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 TIMMONS ST
Mailing Address - Street 2:
Mailing Address - City:SCOBEY
Mailing Address - State:MT
Mailing Address - Zip Code:59263-0250
Mailing Address - Country:US
Mailing Address - Phone:406-487-2650
Mailing Address - Fax:406-487-2620
Practice Address - Street 1:504 TIMMONS ST
Practice Address - Street 2:
Practice Address - City:SCOBEY
Practice Address - State:MT
Practice Address - Zip Code:59263-0250
Practice Address - Country:US
Practice Address - Phone:406-487-2650
Practice Address - Fax:406-487-2620
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD39901223G0001X
MT24251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice