Provider Demographics
NPI:1184724254
Name:COLE, MICHAEL R (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
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:PO BOX 1210
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-1210
Mailing Address - Country:US
Mailing Address - Phone:509-925-6553
Mailing Address - Fax:509-962-6712
Practice Address - Street 1:2401 W DOLARWAY RD
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-9309
Practice Address - Country:US
Practice Address - Phone:509-925-6553
Practice Address - Fax:509-962-6712
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000052371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice