Provider Demographics
NPI:1588718480
Name:VANESSA L COLE DMD PC
Entity type:Organization
Organization Name:VANESSA L COLE DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:L
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-532-2500
Mailing Address - Street 1:516 SOUTH LOCUST STREET
Mailing Address - Street 2:
Mailing Address - City:CENTIALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801
Mailing Address - Country:US
Mailing Address - Phone:618-532-2500
Mailing Address - Fax:618-532-1477
Practice Address - Street 1:516 SOUTH LOCUST STREET
Practice Address - Street 2:
Practice Address - City:CENTIALIA
Practice Address - State:IL
Practice Address - Zip Code:62801
Practice Address - Country:US
Practice Address - Phone:618-532-2500
Practice Address - Fax:618-532-1477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty