Provider Demographics
NPI:1063556793
Name:COHEN, JASON MICHAEL (DDS, MS)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:MICHAEL
Last Name:COHEN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 FOREST AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4812
Mailing Address - Country:US
Mailing Address - Phone:408-298-3433
Mailing Address - Fax:408-298-6304
Practice Address - Street 1:2075 FOREST AVENUE, SUITE 2
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128
Practice Address - Country:US
Practice Address - Phone:408-298-3433
Practice Address - Fax:408-298-6304
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA487121223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics