Provider Demographics
NPI:1487613782
Name:COHEN, JEFFREY M (DDS)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
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 1:3410 N LOS COYOTES DIAGONAL
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-2915
Mailing Address - Country:US
Mailing Address - Phone:562-420-3158
Mailing Address - Fax:562-420-2957
Practice Address - Street 1:3410 N LOS COYOTES DIAGONAL
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-2915
Practice Address - Country:US
Practice Address - Phone:562-420-3158
Practice Address - Fax:562-420-2957
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA381741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice