Healthcare Provider Details

I. General information

NPI: 1396918264
Provider Name (Legal Business Name): NICHOLAS JOHN COLES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7455 E TANQUE VERDE RD
TUCSON AZ
85715-3477
US

IV. Provider business mailing address

11285 N MOUNTAIN BREEZE DR
ORO VALLEY AZ
85737-7246
US

V. Phone/Fax

Practice location:
  • Phone: 520-745-2454
  • Fax:
Mailing address:
  • Phone: 801-891-9606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number8363
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: