Provider Demographics
NPI:1881724896
Name:COLE, RONALD SINCLAIR (DMD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:SINCLAIR
Last Name:COLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 GAINES SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-3198
Mailing Address - Country:US
Mailing Address - Phone:706-353-8053
Mailing Address - Fax:706-353-8756
Practice Address - Street 1:1060 GAINES SCHOOL RD
Practice Address - Street 2:SUITE A-1
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-3198
Practice Address - Country:US
Practice Address - Phone:706-353-8053
Practice Address - Fax:706-353-8756
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA96271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA843-409OtherUNITED CONCORDIA