Provider Demographics
NPI:1386865236
Name:MARC D. COHEN, D.D.S. AND JANA L. KAYE, D.D.S., DENTAL CORP.
Entity Type:Organization
Organization Name:MARC D. COHEN, D.D.S. AND JANA L. KAYE, D.D.S., DENTAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST'S & OWNER'S
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-789-0555
Mailing Address - Street 1:16311 VENTURA BOULEVARD
Mailing Address - Street 2:SUITE 1250
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436
Mailing Address - Country:US
Mailing Address - Phone:818-789-0555
Mailing Address - Fax:818-789-5011
Practice Address - Street 1:16311 VENTURA BOULEVARD
Practice Address - Street 2:SUITE 1250
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436
Practice Address - Country:US
Practice Address - Phone:818-789-0555
Practice Address - Fax:818-789-5011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty