MEDICARE: COLE EIMER DDS

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	1223G0001X	General Practice Dentistry	019037212	IL

General Provider Information

NPI Number	:	1780500967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLE EIMER DDS

Provider Business Mailing Address
First Line	:	58 W FAIRVIEW LN
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62711-9446
Country	:	US
Telephone Number	:	217-691-9353
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 MANSION RD
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62711-6724
Country	:	US
Telephone Number	:	217-483-7177
Fax Number	:

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

Provider Enumeration Date	:	06/24/2026
Last Update Date	:	06/24/2026

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Directions to “ COLE EIMER DDS” Practice Location

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