Provider Demographics
NPI:1124080437
Name:COHEN, IRA (DMD)
Entity type:Individual
Prefix:
First Name:IRA
Middle Name:
Last Name:COHEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 GREAT POND DR
Mailing Address - Street 2:SUITE 2003
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-7244
Mailing Address - Country:US
Mailing Address - Phone:407-772-5124
Mailing Address - Fax:407-788-3572
Practice Address - Street 1:661 MCKEAN AVE
Practice Address - Street 2:
Practice Address - City:DONORA
Practice Address - State:PA
Practice Address - Zip Code:15033-1002
Practice Address - Country:US
Practice Address - Phone:407-772-5124
Practice Address - Fax:407-788-3572
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025536122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011197280017Medicaid
PA0011197280020Medicaid
PA0011197280026Medicaid
PA0011197280018Medicaid
PA0011197280013Medicaid
PA0011197280014Medicaid
PA0011197280025Medicaid
PA0011197280011Medicaid
PA0011197280023Medicaid
PA0011197280024Medicaid
PA0011197280021Medicaid
PA0011197280008Medicaid
PA0011197280022Medicaid