Healthcare Provider Details

I. General information

NPI: 1033529391
Provider Name (Legal Business Name): ADEMOLA O COLE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3486 C EMMORTON ROAD
ABINGDON MD
21009
US

IV. Provider business mailing address

625 ELMWOOD AVE
ROCHESTER NY
14620-2913
US

V. Phone/Fax

Practice location:
  • Phone: 410-200-9081
  • Fax: 585-273-1235
Mailing address:
  • Phone: 585-275-5087
  • Fax: 585-273-1235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number34650
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: