Provider Demographics
NPI:1225079437
Name:COHEN, JAY NORMAN (DDS)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:NORMAN
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 1:902 WOODSIDE RD
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3611
Mailing Address - Country:US
Mailing Address - Phone:650-365-8982
Mailing Address - Fax:650-365-8928
Practice Address - Street 1:902 WOODSIDE RD
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-3611
Practice Address - Country:US
Practice Address - Phone:650-365-8982
Practice Address - Fax:650-365-8928
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA397761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB39776-01OtherDENTICAL
CA782405OtherUNITED CONCORDIA