Provider Demographics
NPI:1114930617
Name:BRUCE D COLE DDS PA
Entity type:Organization
Organization Name:BRUCE D COLE DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-665-7311
Mailing Address - Street 1:PO BOX 229
Mailing Address - Street 2:
Mailing Address - City:OVERBROOK
Mailing Address - State:KS
Mailing Address - Zip Code:66524-0229
Mailing Address - Country:US
Mailing Address - Phone:785-665-7311
Mailing Address - Fax:785-665-7311
Practice Address - Street 1:306 MAPLE
Practice Address - Street 2:
Practice Address - City:OVERBROOK
Practice Address - State:KS
Practice Address - Zip Code:66524-0229
Practice Address - Country:US
Practice Address - Phone:785-665-7311
Practice Address - Fax:785-665-7311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS51731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty