Provider Demographics
NPI:1801277033
Name:STAPP, COLE WILLIAM (DMD)
Entity type:Individual
Prefix:DR
First Name:COLE
Middle Name:WILLIAM
Last Name:STAPP
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 1:625 ELM ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47842-1728
Mailing Address - Country:US
Mailing Address - Phone:765-832-3434
Mailing Address - Fax:
Practice Address - Street 1:625 ELM ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IN
Practice Address - Zip Code:47842-1728
Practice Address - Country:US
Practice Address - Phone:765-832-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100368122300000X
IN12013339A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentist