Active NPI
Randal W Cole, DMD
- General Practice Dentistry
- Mattapan, MA
National Provider Identifier
1306994603
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 17021
- Practice address
- 90 River St
Mattapan, MA 02126-2975 - Phone
- (617) 698-5437
- NPI assigned
- Jan 5, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 17021 | MA | Primary |
Addresses
Primary practice location
90 River St
Mattapan, MA 02126-2975
Mailing address
201 W 8TH St
Suite 810
Pueblo, CO 81003-3038
Phone (719) 562-4447
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0272698 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17021 | MA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1293408000000",
"number": "1306994603",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 W 8TH ST",
"address_2": "SUITE 810",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810033038",
"telephone_number": "719-562-4447"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "90 RIVER ST",
"city": "MATTAPAN",
"state": "MA",
"postal_code": "021262975",
"telephone_number": "617-698-5437"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLE",
"first_name": "RANDAL",
"middle_name": "W",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-05",
"last_updated": "2010-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MA",
"license": "17021",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0272698",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mattapan, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.