Provider Demographics
NPI:1366686214
Name:JOHN COHEN D D S DENTAL CORPORATION
Entity type:Organization
Organization Name:JOHN COHEN D D S DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-412-8013
Mailing Address - Street 1:10823 HAWTHORNE BLVD
Mailing Address - Street 2:A & B
Mailing Address - City:LENNOX
Mailing Address - State:CA
Mailing Address - Zip Code:90304-4317
Mailing Address - Country:US
Mailing Address - Phone:310-412-8013
Mailing Address - Fax:310-412-7970
Practice Address - Street 1:10823 HAWTHORNE BLVD
Practice Address - Street 2:A & B
Practice Address - City:LENNOX
Practice Address - State:CA
Practice Address - Zip Code:90304-4317
Practice Address - Country:US
Practice Address - Phone:310-412-8013
Practice Address - Fax:310-412-7970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental