Provider Demographics
NPI:1720260383
Name:COLE FAMILY DENTISTRY
Entity type:Organization
Organization Name:COLE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:MOSELEY
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-310-0688
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MS
Mailing Address - Zip Code:39073-0185
Mailing Address - Country:US
Mailing Address - Phone:601-845-6357
Mailing Address - Fax:
Practice Address - Street 1:2614 HIGHWAY 49 S
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MS
Practice Address - Zip Code:39073-9415
Practice Address - Country:US
Practice Address - Phone:601-845-6357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3334-051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty