MEDICARE: MR. BRETT HADLEY 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	1223E0200X	Endodontics	39389	CA

General Provider Information

NPI Number	:	1700051893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRETT HADLEY COLE DDS

Provider Business Mailing Address
First Line	:	895 MORAGA RD
Second Line	:	4
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-5039
Country	:	US
Telephone Number	:	925-283-2735
Fax Number	:	925-283-2248

Provider Business Practice Location Address
First Line	:	895 MORAGA RD
Second Line	:	4
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-5039
Country	:	US
Telephone Number	:	925-283-2735
Fax Number	:	925-283-2248

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

Provider Enumeration Date	:	04/29/2008
Last Update Date	:	04/29/2008

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