Healthcare Provider Details

I. General information

NPI: 1316730153
Provider Name (Legal Business Name): KELLEY JANE COLE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2025
Last Update Date: 08/15/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5716 MICHIGAN AVE
DETROIT MI
48210-3039
US

IV. Provider business mailing address

22201 MOROSS RD STE 155
DETROIT MI
48236-2152
US

V. Phone/Fax

Practice location:
  • Phone: 313-554-3880
  • Fax: 313-228-0283
Mailing address:
  • Phone: 313-499-4775
  • Fax: 313-499-4953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4301094326
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: