Provider Demographics
NPI:1366413361
Name:COLE, HARRY RICHARD JR (DDS)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:RICHARD
Last Name:COLE
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3912 ROCK RIVER LANE
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902
Mailing Address - Country:US
Mailing Address - Phone:619-773-7577
Mailing Address - Fax:
Practice Address - Street 1:1755 TELSTAR DR STE 250
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1016
Practice Address - Country:US
Practice Address - Phone:719-599-0500
Practice Address - Fax:719-599-0575
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-28
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO84041223S0112X
CO85041223S0112X
CA599801223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery