Provider Demographics
NPI:1972679967
Name:COLE, LEWIS C (DMD)
Entity type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:C
Last Name:COLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 ENERGY CENTER BLVD
Mailing Address - Street 2:SUITE 1603
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-5830
Mailing Address - Country:US
Mailing Address - Phone:205-344-6900
Mailing Address - Fax:
Practice Address - Street 1:525 ENERGY CENTER BLVD
Practice Address - Street 2:SUITE 1603
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-5830
Practice Address - Country:US
Practice Address - Phone:205-344-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5467122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA993983OtherUNITED CONCORDIA