Provider Demographics
NPI:1740442920
Name:COLE, MATTHEW DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DAVID
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 1:1401 S RANCHWOOD BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-2760
Mailing Address - Country:US
Mailing Address - Phone:405-354-4806
Mailing Address - Fax:405-354-1277
Practice Address - Street 1:1401 S RANCHWOOD BLVD STE 110
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-2760
Practice Address - Country:US
Practice Address - Phone:405-354-4806
Practice Address - Fax:405-354-1277
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK60611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice