Healthcare Provider Details

I. General information

NPI: 1144240888
Provider Name (Legal Business Name): NATHANIEL WILLIAM COLE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 W PARK AVE SUITE 3
DU BOIS PA
15801-2277
US

IV. Provider business mailing address

905 CHESTNUT AVE
DU BOIS PA
15801-2605
US

V. Phone/Fax

Practice location:
  • Phone: 814-375-1083
  • Fax:
Mailing address:
  • Phone: 814-371-2669
  • Fax: 814-371-3689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS024192L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: