MEDICARE: DR. MICHEAL ANTHONY 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	1223G0001X	General Practice Dentistry	20267	TX

General Provider Information

NPI Number	:	1356467468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHEAL ANTHONY COLE DDS

Provider Business Mailing Address
First Line	:	6500 S FLORES ST
Second Line	:	#102
City	:	SAN ANTONIO
State	:	TX
Zip	:	78214-2628
Country	:	US
Telephone Number	:	210-924-5933
Fax Number	:	210-924-5934

Provider Business Practice Location Address
First Line	:	6500 S FLORES ST
Second Line	:	#102
City	:	SAN ANTONIO
State	:	TX
Zip	:	78214-2628
Country	:	US
Telephone Number	:	210-924-5933
Fax Number	:	210-924-5934

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

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	07/08/2007

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