Healthcare Provider Details

I. General information

NPI: 1689509960
Provider Name (Legal Business Name): COLE TOBOLA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 S PENNSYLVANIA AVE
LANSING MI
48910-1897
US

IV. Provider business mailing address

2345 CLUB MERIDIAN DR APT B5
OKEMOS MI
48864-4538
US

V. Phone/Fax

Practice location:
  • Phone: 517-372-5051
  • Fax:
Mailing address:
  • Phone: 586-295-0527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901603060
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: