John Robert Cole, DDS
Individual provider Active NPI Dentist · Boise, ID
NPI 1295543304 · NPPES record last updated Dec 20, 2024
Key facts
- NPI
- 1295543304
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 3571039 (ID)
- Practice address
- 607 N Mitchell St
Boise, ID 83704-4863 - Phone
- (855) 433-6825
- NPI assigned
- Dec 20, 2024
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3571039 | ID | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 3571039 | ID | Yes |
Addresses
Primary practice location
607 N Mitchell St
Boise, ID 83704-4863
Mailing address
6950 NE Campus Way
Hillsboro, OR 97124-5611
Phone (855) 433-6825
Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.