Provider Demographics
NPI:1437230810
Name:COHEN, JEFFREY MARK (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MARK
Last Name:COHEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:436 N ROXBURY DR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5026
Mailing Address - Country:US
Mailing Address - Phone:310-247-8880
Mailing Address - Fax:310-246-6691
Practice Address - Street 1:436 N ROXBURY DR
Practice Address - Street 2:SUITE 215
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5026
Practice Address - Country:US
Practice Address - Phone:310-247-8880
Practice Address - Fax:310-246-6691
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA388241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics