Provider Demographics
NPI:1194420018
Name:MULKEY, COLE
Entity type:Individual
Prefix:
First Name:COLE
Middle Name:
Last Name:MULKEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 NEOLA RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-5446
Mailing Address - Country:US
Mailing Address - Phone:903-456-9158
Mailing Address - Fax:
Practice Address - Street 1:4873 HIGHWAY 90 STE A
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32571-1401
Practice Address - Country:US
Practice Address - Phone:850-602-9033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL292401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice