Provider Demographics
NPI:1548376270
Name:COLE, JAMES R (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:COLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:850 E MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-2726
Mailing Address - Country:US
Mailing Address - Phone:505-327-0441
Mailing Address - Fax:505-324-9473
Practice Address - Street 1:850 E MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-2726
Practice Address - Country:US
Practice Address - Phone:505-327-0441
Practice Address - Fax:505-324-9473
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD-1790122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM5912Medicaid
NM86781Medicaid