Healthcare Provider Details

I. General information

NPI: 1366413361
Provider Name (Legal Business Name): HARRY RICHARD COLE JR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2006
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 TELSTAR DR STE 250
COLORADO SPRINGS CO
80920-1016
US

IV. Provider business mailing address

3912 ROCK RIVER LANE
BONITA CA
91902
US

V. Phone/Fax

Practice location:
  • Phone: 719-599-0500
  • Fax: 719-599-0575
Mailing address:
  • Phone: 619-773-7577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number8404
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number8504
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number59980
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: