MEDICARE: DR. KISHAWN OLASUPO KOLE-JAMES D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2901019444	MI
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	19444	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073688818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KISHAWN OLASUPO KOLE-JAMES D.D.S

Provider Business Mailing Address
First Line	:	PO BOX 2879
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-0879
Country	:	US
Telephone Number	:	313-282-5651
Fax Number	:

Provider Business Practice Location Address
First Line	:	1799 E GRAND BLVD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48211-3145
Country	:	US
Telephone Number	:	313-282-5651
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	09/30/2022

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