Provider Demographics
NPI:1073790986
Name:COHEN, CHARLES D (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:D
Last Name:COHEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97B SUGARLOAF ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH DEERFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01373-1145
Mailing Address - Country:US
Mailing Address - Phone:413-665-4393
Mailing Address - Fax:
Practice Address - Street 1:97B SUGARLOAF ST
Practice Address - Street 2:
Practice Address - City:SOUTH DEERFIELD
Practice Address - State:MA
Practice Address - Zip Code:01373-1145
Practice Address - Country:US
Practice Address - Phone:413-665-4393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA174021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice