Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 14389 | TX |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 14389 | TX |
NPI | 1841390473 |
---|---|
Provider Name | Dr. Michael Dean Cole |
First Address | Burleson, TX 76028 |
Second Address | Burleson, TX 76028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2006 |
Last Update Date | 01/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14389 | TEXAS STATE BOARD OF DENT (01) | TX |