Provider Demographics
NPI:1679005086
Name:COLE, SHAYA (RDH)
Entity type:Individual
Prefix:
First Name:SHAYA
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4870 MT PRINCETON ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-6503
Mailing Address - Country:US
Mailing Address - Phone:303-870-1823
Mailing Address - Fax:
Practice Address - Street 1:4870 MT PRINCETON ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-6503
Practice Address - Country:US
Practice Address - Phone:303-870-1823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist