Individual
JONATHAN KING COLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
190 W PARK AVE STE 4, DU BOIS, PA 15801-2277
(814) 375-7515
(814) 375-1270
Mailing address
318 HILLCREST DR, DU BOIS, PA 15801-2342
(814) 375-8990
(814) 371-0290
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
DS024511L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
112780
INSURANCE PROVIDER ID
PA
Enumeration date
08/18/2006
Last updated
07/08/2007
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