Provider Demographics
NPI:1033523352
Name:COHEN, GREGORY EZRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:EZRA
Last Name:COHEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 SOCIETY HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2416
Mailing Address - Country:US
Mailing Address - Phone:856-905-9621
Mailing Address - Fax:
Practice Address - Street 1:929 SOCIETY HILL BLVD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2416
Practice Address - Country:US
Practice Address - Phone:856-905-9621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0400241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice