Provider Demographics
NPI:1104817113
Name:COLE, DONALD E (DDS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:E
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:US ARMY DENTAL ACTIVITY / CREDENTIALS
Mailing Address - Street 2:10590 ENDURING FREEDOM DRIVE
Mailing Address - City:FORT DRUM
Mailing Address - State:NY
Mailing Address - Zip Code:13602-5005
Mailing Address - Country:US
Mailing Address - Phone:315-772-6234
Mailing Address - Fax:315-774-3558
Practice Address - Street 1:US ARMY DENTAL ACTIVITY / CREDENTIALS
Practice Address - Street 2:10590 ENDURING FREEDOM DRIVE
Practice Address - City:FORT DRUM
Practice Address - State:NY
Practice Address - Zip Code:13602-5005
Practice Address - Country:US
Practice Address - Phone:315-772-6234
Practice Address - Fax:315-774-3558
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190161981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN