Healthcare Provider Details

I. General information

NPI: 1023421757
Provider Name (Legal Business Name): KASANDRA SUE COLE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 DOUGLAS PKWY
PIKEVILLE KY
41501-6970
US

IV. Provider business mailing address

1709 KY ROUTE 321 SUITE 3
PRESTONSBURG KY
41653-9097
US

V. Phone/Fax

Practice location:
  • Phone: 606-639-3135
  • Fax: 606-639-3136
Mailing address:
  • Phone: 606-886-8546
  • Fax: 606-886-8548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9482
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: