Provider Demographics
NPI:1487601308
Name:COHEN, SCOTT A (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:COHEN
Suffix:
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 1:835 E 65TH ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4421
Mailing Address - Country:US
Mailing Address - Phone:912-353-9533
Mailing Address - Fax:912-356-0320
Practice Address - Street 1:835 E 65TH ST
Practice Address - Street 2:SUITE 108
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4421
Practice Address - Country:US
Practice Address - Phone:912-353-9533
Practice Address - Fax:912-356-0320
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00400078BMedicaid