Provider Demographics
NPI:1073762506
Name:COHEN, JESSICA CAMILLE (DDS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:CAMILLE
Last Name:COHEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 2ND AVE N STE 303
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5702
Mailing Address - Country:US
Mailing Address - Phone:239-351-2000
Mailing Address - Fax:239-351-1880
Practice Address - Street 1:700 2ND AVE N STE 303
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5702
Practice Address - Country:US
Practice Address - Phone:239-351-2000
Practice Address - Fax:239-351-1880
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0535671223P0300X
FLDN168431223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics