Provider Demographics
NPI:1992506984
Name:COHEN, RAFAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:
Last Name:COHEN
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6677 SANTA MONICA BLVD APT 1507
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-1469
Mailing Address - Country:US
Mailing Address - Phone:747-717-9265
Mailing Address - Fax:
Practice Address - Street 1:6677 SANTA MONICA BLVD APT 1507
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038-1469
Practice Address - Country:US
Practice Address - Phone:747-717-9265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111332122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist