Provider Demographics
NPI:1487675237
Name:COHEN, MARVIN JAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:JAY
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 1:625 N CHARLOTTE ST
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-4645
Mailing Address - Country:US
Mailing Address - Phone:610-323-9351
Mailing Address - Fax:610-326-9360
Practice Address - Street 1:625 N CHARLOTTE ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-4645
Practice Address - Country:US
Practice Address - Phone:610-323-9351
Practice Address - Fax:610-326-9360
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS015864L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA62466OtherUNITED CONCORDIA