Provider Demographics
NPI:1104886951
Name:COHEN, JEROME ARTHUR (DDS08)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:ARTHUR
Last Name:COHEN
Suffix:
Gender:M
Credentials:DDS08
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 OLD RICHMOND AVE
Mailing Address - Street 2:SUITE G-27
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1828
Mailing Address - Country:US
Mailing Address - Phone:804-285-7525
Mailing Address - Fax:804-285-6650
Practice Address - Street 1:5700 OLD RICHMOND AVE
Practice Address - Street 2:SUITE G-27
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1828
Practice Address - Country:US
Practice Address - Phone:804-285-7525
Practice Address - Fax:804-285-6650
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010042221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice