MEDICARE: DR. TODD J COLE DDS

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	122300000X	Dentist	019-023602	IL

General Provider Information

NPI Number	:	1336134097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TODD J COLE DDS

Provider Business Mailing Address
First Line	:	2602 LAKE REUNION RD
Second Line	:
City	:	DECATUR
State	:	IL
Zip	:	62521-8407
Country	:	US
Telephone Number	:	217-423-0607
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 CASA PARK DR
Second Line	:
City	:	MT ZION
State	:	IL
Zip	:	62549-1757
Country	:	US
Telephone Number	:	217-864-6016
Fax Number	:

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	12/13/2014

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Directions to “ DR. TODD J COLE DDS” Practice Location

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