Provider Demographics
NPI:1104935642
Name:COLE, DAVID HIRAM (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HIRAM
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 1:104 W GARLAND
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-2410
Mailing Address - Country:US
Mailing Address - Phone:870-234-4425
Mailing Address - Fax:870-234-1910
Practice Address - Street 1:104 W GARLAND
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-2410
Practice Address - Country:US
Practice Address - Phone:870-234-4425
Practice Address - Fax:870-234-1910
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR28991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR58400OtherBCBS IDENTIFICATION NUMBE