Provider Demographics
NPI:1386057040
Name:COLE DENTAL
Entity type:Organization
Organization Name:COLE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOWER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:208-377-8383
Mailing Address - Street 1:1166 N COLE RD STE A
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8658
Mailing Address - Country:US
Mailing Address - Phone:208-377-8383
Mailing Address - Fax:208-377-1833
Practice Address - Street 1:1166 N COLE RD STE A
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8658
Practice Address - Country:US
Practice Address - Phone:208-377-8383
Practice Address - Fax:208-377-1833
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPHANIE J MOWER DMD PLLC DBA COLE DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD4546122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty