Active NPI
Colin Alfred Dole, DMD
- Dentist
- Bend, OR
National Provider Identifier
1578949541
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D10328
- Practice address
- 1201 NW Wall St
Bend, OR 97701-1956 - Phone
- (458) 206-0953
- NPI assigned
- Jul 31, 2015
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | D10328 | OR | Primary |
Addresses
Primary practice location
1201 NW Wall St
Bend, OR 97701-1956
Mailing address
1725 SW Forest Ridge Ave
Apt D
Bend, OR 97702-1925
Phone (208) 790-0454
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160106002371 | OR | Order and Referring Only - Dentist | 2769784875 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D10328 | OR | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1438300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1438300800000",
"number": "1578949541",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1725 SW FOREST RIDGE AVE",
"address_2": "APT D",
"city": "BEND",
"state": "OR",
"postal_code": "977021925",
"telephone_number": "208-790-0454"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1201 NW WALL ST",
"city": "BEND",
"state": "OR",
"postal_code": "977011956",
"telephone_number": "458-206-0953"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOLE",
"first_name": "COLIN",
"middle_name": "ALFRED",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-07-31",
"last_updated": "2015-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "D10328",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.