Provider Demographics
NPI:1073585022
Name:COHEN, JEFFREY S (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
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 1:2300 HAGGERTY RD
Mailing Address - Street 2:SUITE 2030
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2184
Mailing Address - Country:US
Mailing Address - Phone:248-669-6600
Mailing Address - Fax:248-669-6606
Practice Address - Street 1:2300 HAGGERTY RD
Practice Address - Street 2:SUITE 2030
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2184
Practice Address - Country:US
Practice Address - Phone:248-669-6600
Practice Address - Fax:248-669-6606
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0171201223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI9756312600OtherBLUE CROSS BLUE SHIELD
MI5501140OtherBLUE CARE NETWORK
MI1781844OtherUNITED CONCRODIA
MI1781844OtherUNITED CONCRODIA