Provider Demographics
NPI:1871602649
Name:COLE, MICHAEL SHAY (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SHAY
Last Name:COLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1583 COMMON STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130
Mailing Address - Country:US
Mailing Address - Phone:830-629-1954
Mailing Address - Fax:830-625-3114
Practice Address - Street 1:1583 COMMON STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130
Practice Address - Country:US
Practice Address - Phone:830-629-1954
Practice Address - Fax:830-625-3114
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXD20481122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87D656OtherBLUE CROSS BLUE SHIELD
TX1399228OtherUNITED CONCORDIA