Provider Demographics
NPI:1952438178
Name:COLE, KATHLEEN ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:ANN
Last Name:COLE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1ST MEDICAL GROUP
Mailing Address - Street 2:45 PINE STREET
Mailing Address - City:LANGLEY AFB
Mailing Address - State:VA
Mailing Address - Zip Code:23665-2080
Mailing Address - Country:US
Mailing Address - Phone:757-225-7630
Mailing Address - Fax:757-764-1238
Practice Address - Street 1:1ST MEDICAL GROUP
Practice Address - Street 2:45 PINE STREET
Practice Address - City:LANGLEY AFB
Practice Address - State:VA
Practice Address - Zip Code:23665-2080
Practice Address - Country:US
Practice Address - Phone:757-225-7630
Practice Address - Fax:757-764-1238
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014112091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice