MEDICARE: DR. JAMES R. COLE D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DD-1790	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548376270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES R. COLE D.D.S.

Provider Business Mailing Address
First Line	:	850 E MAIN ST
Second Line	:	SUITE A
City	:	FARMINGTON
State	:	NM
Zip	:	87401-2726
Country	:	US
Telephone Number	:	505-327-0441
Fax Number	:	505-324-9473

Provider Business Practice Location Address
First Line	:	850 E MAIN ST
Second Line	:	SUITE A
City	:	FARMINGTON
State	:	NM
Zip	:	87401-2726
Country	:	US
Telephone Number	:	505-327-0441
Fax Number	:	505-324-9473

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	07/09/2007

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