Provider Demographics
NPI:1154492379
Name:COHEN, JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
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 1:10823 HAWTHORNE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LENNOX
Mailing Address - State:CA
Mailing Address - Zip Code:90304-4322
Mailing Address - Country:US
Mailing Address - Phone:818-786-6000
Mailing Address - Fax:818-786-8820
Practice Address - Street 1:10823 HAWTHORNE BLVD STE A
Practice Address - Street 2:
Practice Address - City:LENNOX
Practice Address - State:CA
Practice Address - Zip Code:90304-4322
Practice Address - Country:US
Practice Address - Phone:818-786-6000
Practice Address - Fax:818-786-8820
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40423122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB40423-01OtherDENTICAL PROVIDER NUMBER